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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 Penggunaan Diazepam Rektal dan Midazolam Intravena sebagai Sedasi untuk Prosedur CT-Scan Kepala Penderita Pediatri di RSU Dr. Soetomo Surabaya Erfprinsi Wohon; Siti Chasnak Saleh
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
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Latar Bekang dan Tujuan: Dalam lima tahun terakhir ini terdapat peningkatan prosedur diagnostic invasive, radiologi dan bedah minor pada penderita anak yang dilakukan diluar kamar operasi. Salah satu tindakan tersebut adalah CT (computed tomography) scan yang dikenal sebagai teknik neuroradiology noninvasive sejak 1973. Pada penderita anak diperlukan peran dokter anestesi saat dilakukan prosedur CT-Scan, karena biasanya anak tidak kooperatif sehingga perlu sedasi. Golongan benzodiazepine merupakan obat premediksi yang terkenal karena menghilangkan cemas, memberi sedasi dan menimbulkan amnesia dengan depresi kardiovaskuler dan respirasi yang minimal. Midazolam sering digunakan untuk sedasi karena memberikan efek amnesia, penggunannya mudah dan efeknya singkat. Dizepam dapat digunakan untuk memberikan sedasi pada penderita anak karena mudah penggunaannya, mudah didapat murah, dan tersedia dalam preparat supositora yang dapat digunakan bila didapatkan kesulitan mendapat jalur infus intravena.Subjek dan Metode: Penelitian dilakukan pada 30 anak yang akan menjalani tindakan CT-scan, dan telah mendapat persetujuan dari komite etik penelitian Dr. soeomo Surabaya. Penderita dibagi menjadi 2 kelompok secsara acak yaitu kelompok kontrol dan perlakuan. Kelompok control mendapat sedasi midazolam 0,05-0,1 mg/kgBB intravena. Kelompok perlakuan mendapat sedasi diazepam 5 mg melalui rektal. Kepada keluarga penderita telah diberikan penjelasan tentang teknik pemberian sedasi, dan telah menyetujuiHasil: setelah pemberian sedasi terjadi peningkatan tingkat sedasi tidak berbeda antara kedua kelompok (p0,05). Perubahan hemodinamik (nadi, MAP, frekuensi nafas dan saturasi oksigen) antara kedua kelompok ada perbedaan namun tidak bermakna. Tidak ada munculnya efek samping seperti bradikardi, hipotensi, bradipneu, desaturase dan mual muntah pada kedua kelompok. Lamanya waktu pulih sadar antara kedua kelompok ada perbedaan tetapi tidak bermakna (p=0,851)Simpulan: Diazepam rektal 5 mg memiliki efek sedasi yang sama dengan midazolam 0,05-0,1 mg/kgBB.Comparison of Rectal Diazepam and Intravenous Midazolam as Sedation for Pediatric Patients Undergoing Head Computed Tomography at Dr. soetomo General Hospital SurabayaBackground and Objective: Invasive diagnostic, radiology and minor surgical procedures on pediatric patients outside the operating room setting have increased last 5 years, such as Computed tomography scanning have been known as noninvasive neuroradiology technique sine 1973. Childrens who undergo computed tomography (CT) often require sedation due to uncooperativeness to minimize metion artifacts. Currently, benzodiazepines are popular preanesthetic medications because their anxiolytic, sedative, and amnestic properties are combined with minimal cardiovascular and respiratory depression. Midazolam are frequently used for sedation because of amnestic effect, easy to use and short acting. Dizepam could be used for sedation to pediatric patients because of easy to use, easy to obtain, cheap and available in suppositoria, that could be used if we cannot find the intravenous line.Subjects and Methods: 30 patients are devided randomly into 2 groups, one group are given intravenous midazolam 0.05-0.1 mg/kg, and other group are given rectal diazepam 5 mg. Before the sedation, the [parents of the patients were explained the sedation techniques, vital signs observation during the sedation until in the recovery roomResults: The sedation level are increase in two groups (p0.05). There are vital signs changes in two group but not significant. No side effects such as bradycardia, hypertension, bradpneu, desaturation dan nausea-vomitting are occurred. Recovery time between two groups are different but it is not significant (p=0.851).

Hubungan antara Volume Residu Gaster dan Skor Glasgow Coma Scale (GCS) pada Pasien Cedera Otak Traumatik Sedang dan Berat Giovanni, Cindy; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
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Latar Belakang dan Tujuan: Cedera Otak Traumatik (COT) berhubungan dengan disfungsi gastrointestinal berupa perlambatan pengosongan lambung. Belum jelas adakah hubungan antara skor Glasgow Coma Scale (GCS) dan derajat gangguan pengosongan lambung yang terjadi. Penelitian ini bertujuan untuk membandingkan volume residu gaster pada pasien COT sedang dan berat serta mengkaji hubungan antara skor GCS dan volume residu gaster pada pasien COT.Subjek dan Metode: Penelitian observasional analitik cross-sectional ini dilakukan pada 42 pasien COT sedang dan berat yang dirawat di RSUP Dr. Hasan Sadikin dari bulan Desember 2016 hingga Juni 2017. Pengukuran volume residu gaster, skor GCS, dan tanda vital dilakukan tiap 6 jam selama 48 jam. Data hasil penelitian diuji dengan uji t tidak berpasangan, Chi Square, dan uji korelasi Pearson. Hasil: Hasil penelitian menyatakan bahwa rerata volume residu gaster pada kelompok COT sedang dan berat adalah 10,83 8,15 ml dan 50,59 18,23 ml (p 0,000). Korelasi antara skor GCS dan volume residu gaster menunjukkan adanya korelasi negatif yang bermakna dan sangat kuat (r=-0,745 hingga -,974;p=0,000).Simpulan: Volume residu gaster pada COT berat lebih banyak dari COT sedang dan terdapat hubungan antara skor GCS dan volume residu gaster pada pasien COT.Correlation between Gastric Residual Volume and Glasgow Coma Scale (GCS) Score in Patient with Moderate and Severe Traumatic Brain InjuryBackground and Objective: Traumatic Brain Injury (TBI) is associated with gastrointestinal dysfunction in the form of delayed gastric emptying. It is not clear whether there is a relationship between Glasgow Coma Scale (GCS) score and the degree of gastric emptying that occurs. This study aimed to compare gastric residual volume in moderate and severe TBI patients and to examine the relationship between GCS score and gastric residual volume in TBI patients.Subject and Methods: This cross-sectional analytical observational study was conducted on 42 moderate and severe TBI patients who were admitted to Dr. Hasan Sadikin from December 2016 to June 2017. Measurement of gastric residual volume, GCS score, and vital signs were performed every 6 hours for 48 hours. The result data were tested with unpaired t-test, Chi Square, and Pearson correlation test. Results: The results showed that the mean gastric residual volume in moderate and severe TBI groups was 10.83 8.15 ml and 50.59 18.23 ml (p 0.000). The correlation between GCS and gastric residual volume showed a very strong negative correlation (r=-0,745 to -,974;p=0,000).Conclusion: Gastric residual volume in patient with severe TBI is more than gastric residual volume in moderate TBI and there was a relationship between GCS score and gastric residual volume in TBI patients.

Disseminated Intravascular Coagulation pada Cedera Otak Traumatik Suyasa, Agus Baratha; Sudadi, Sudadi; Suryono, Bambang
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Disseminated Intravascular Coagulation (DIC) merupakan konsekuensi yang sering dan penting pada cedera otak traumatik (Traumatic Brain Injury/TBI) dan menyebabkan cedera otak sekunder. Walaupun perkembangan proses ini belum dapat dijelaskan secara keseluruhan, namun abnormalitas koagulasi darah adalah bukti yang ditemukan pascatrauma. DIC adalah proses patofisiologi dan bukan merupakan suatu penyakit tersendiri. Gangguan yang terjadi meliputi ketidaktepatan, berlebihan dan aktivasi proses hemostasis yang tidak terkontrol. Karakteristik DIC adalah konsumsi faktor pembekuan darah dan trombosit dalam sirkulasi yang menimbulkan berbagai derajat obstruksi pembuluh darah mikro sehubungan dengan deposisi fibrin. Masalah dan gambaran utama akut DIC adalah perdarahan. Gangguan mekanisme hemostatik sangat penting dalam TBI. Perdarahan mikro sering terjadi di parenkim otak dan status koagulasi normal adalah penting untuk mencegah perkembangannya menjadi hematom yang lebih besar. Abnormalitas koagulasi tidak hanya hasil dari cedera, tetapi juga menyebabkan cedera sekunder. Gangguan koagulasi dalam TBI sangat kompleks dan dapat disertai dengan koagulopati dan hiperkoagulabilitas. Di temukan bukti bahwa luasnya trauma jaringan otak memiliki peran penting terhadap gangguan koagulasi dibandingkan syok traumatik maupun hipoksia. Adanya koagulopati pada TBI mengindikasikan prognosis yang buruk, sehingga pemeriksaan rutin terhadap status koagulasi harus selalu dilakukan pada semua pasien TBI. Disseminated Intravascular Coagulation on Traumatic Brain InjuryDisseminated Intravascular Coagulation (DIC) is a frequent and important consequence of traumatic brain injury and may cause secondary brain injury. Although the mechanism of this process cannot be explained as a whole, but abnormalities of blood coagulation after trauma is the evidence. DIC in brain trauma is a pathophysiological process and is not due to a disease in itself. Disturbance includes inaccuracy, excessive and activation of uncontrolled hemostasis process. Characteristic of DIC is the consumption of blood clotting factors and platelets in the circulation that cause various degrees of micro vascular obstruction in conjunction with the deposition of fibrin. The main problem features of acute DIC are bleeding. Impaired hemostatic mechanism plays an important role in traumatic brain injury (TBI). Micro bleeding often occurs in the brain parenchyma and normal coagulation status is important to prevent its development into a larger hematoma. Coagulation abnormality is not the only discouraging factor of injury, but also lead to secondary injury. Coagulation disorders in TBI are very complex and can be accompanied by coagulopathy and hypercoagulability. Found evidence ofextented trauma in the brain tissue plays more important role to coagulation disorder than traumatic shock and hypoxia. The presence of coagulopathy in TBI indicates a poor prognosis, so the routine inspection of the coagulation status should always be performed in all patients with TBI.

Apa yang Baru dalam Neuroanestesi untuk Cedera Otak Traumatik? Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Konsep dasar Neuroanestesi Neuro Critical Care disebut sebagai ABCDE neuroanestesi. Early Brain Injury (EBI) dahulu dikenal sebagai cedera otak primer. Pada EBI terjadi hilangnya autoregulasi, hilangnya integritas barier darah otak. Adanya Trias Cushing menunjukkan adanya hipertensi intrakranial. Target tekanan darah pada cedera otak traumatik (traumatic brain injury/TBI) adalah hindari tekanan darah sistolik 110 mmHg, pertahankan tekanan perfusi otak (cerebral perfusion pressure/CPP) 60-70 mmHg, target pengaturan PaCO2 adalah normokarbia, PaCO2 3540 mmHg, penggunaan profilaksis phenytoin atau valproate tidak direkomendasikan untuk mencegah late post traumatic seizure (late PTS). Masih perlu menganalisa terapi decompressive craniectomy (DECRA) dibandingkan dengan terapi medikal kontinyu untuk peningkatan tekanan intrakranial (intracranial pressure/ICP) yang refrakter setelah TBI. Anestesi umum untuk pasien dengan TBI berat lebih baik dengan total intravenous anesthesia (TIVA), pemberian cairan harus mempertimbangkan osmolaritas cairan tersebut. Pada konsep yang baru, pada pasien dengan peningkatan ICP, konsentrasi anestetika volatil harus dibatasi sampai 0,5 MAC. Target gula darah adalah normoglikemia. Hipotermi profilaksis atau terapeutik tampaknya tidak memiliki tempat dalam pengelolaan cedera otak berat.What is New in Neuroanesthesia for Traumatic Brain Injury?AbstractThe basic concept of Neuroanesthesia and Neuro Critical Care is referred to as ABCDE neuroanesthesia. Early Brain Injury (EBI) was formerly know as primary brain injury. In EBI, there is loss of autoregulation, loss of integrity of the blood-brain barriere. The presence of Cushings triad indicates the presence of intracranial hypertension. Blood pressure target in traumatic brain injury is to avoid systolic blood pressure less than 110 mmHg, maintain cerebral perfusion pressure (CPP) 60-70 mmHg, target PaCO2 regulation is normocarbia, PaCO2 35-40 mmHg, prophylactic use of phenytoin or valproate is not recommended to prevent late post traumatic seizure (late PTS). Still need to analyse decompressive craniectomy (DECRA) compare with continuous medical therapy for refractory increase in intracranial pressure (ICP) after TBI. General anesthesia for patient with severe TBI is better with total intravenous anesthesia (TIVA), administration of fluids must consider the osmolarity of the fluid. In a new concept in patient with elevated ICP, volatile anesthetic concentaratiom should be limited to 0.5 MAC.Blood glucose target is normoglycemia. Prophylactic and therapeutic hypothermia not recommended for severe traumatic brain injury management.

Penatalaksanaan Anestesi untuk Gabungan Tindakan Seksio Sesarea dan Kraniotomi Tumor Otak Wullur, Caroline; Boesoirie, M. Adli; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Angka kejadian tumor intrakranial pada masa kehamilan sangat jarang. Keluhan seperti mual, muntah, nyeri kepala dan gangguan penglihatan serupa dengan hiperemesis dan eklampsia. Sebagian besar pasien tidak memerlukan tindakan emergensi namun pada beberapa kasus, kraniotomi tumor otak dilakukan lebih awal atau bahkan bersamaan dengan seksio sesarea. Seorang wanita 40 tahun, G3P2A0 datang dengan penurunan kesadaran GCS 6 (E2M2V2). CT-scan menunjukkan adanya masa pada daerah temporoparietal kiri, curiga high grade glioma, disertai dengan pergeseran midline dan perdarahan intratumoral. Pemeriksaan obstetri menunjukkan usia kehamilan 32 minggu dengan gawat janin. Dengan pertimbangan resiko herniasi dan gawat janin, pasien menjalani operasi emergensi seksio sesarea diikuti dengan kraniotomi tumor otak. Operasi berlangsung selama 6 jam. Pada pasien hamil dengan tumor otak, waktu pembedahan bergantung pada jenis tumor, usia kehamilan dan kondisi janin. Keberhasilan anestesi bergantung pada pengetahuan menyeluruh mengenai fisiologi dan farmakologi wanita hamil yang disesuaikan dengan individu terkait untuk mengontrol tekanan intrakranial, dengan tujuan menjaga kesejahteraan ibu dan anak.Anaesthetic Management for Combined Emergency Cesarean Section and Craniotomy Tumor RemovalThe occurrence of primary intracranial tumors in pregnancy is an extremely rare event. Symptoms of brain tumor include nausea, vomitting, headache, visual disturbances and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. These central nervous system disorders seldom require immediate surgical attention during pregnancy. However in very few cases, craniotomy tumor removal is performed earlier or even simultaneous with fetal delivery. A 40-year-old woman at 32 weeks of gestation presented to the emergency room with decreased level of consciousness GCS 6 (E2M2V2). CT scan revealed a mass lesion over the left temporoparietal region, suggestive of a high grade glioma, with midline shift and intratumoral bleeding. Obstetric examination revealed a single live fetus of 32 weeks gestation in distress. In view of high risk of herniation and fetal distress, she underwent emergency cesaren section followed by craniotomy tumor removal. Both procedures were completed in 6 hours. In a parturient with brain tumor, the time of combined surgery of tumor removal and cesarean section is decided upon clinical symptoms, type of tumor, gestational age and fetal viability. A successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of both mother and fetus.

Manajemen Neuroanestesi pada Operasi Carotid Endarterectomy: Pasien dengan Riwayat Stroke Berulang Bangun, Chrismas Gideon; Irina, RR. Sinta; Bisri, Dewi Yulianti; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Carotid endarterectomy (CEA) adalah prosedur bedah yang dilakukan untuk memulihkan aliran darah karotis dan mengurangi kejadian stroke embolik dan trombotik. Walaupun merupakan prosedur preventif, CEA membawa risiko komplikasi perioperatif: neurologik dan kardiak. Komplikasi mayor CEA adalah stroke intra dan postoperatif, infark miokard, dan kematian. Untuk mengurangi angka kejadian stroke intraoperatif maka dikembangkan teknologi monitoring intraoperatif salah satunya dengan elektroensefalogram (EEG). Pada kasus ini pasien laki-laki, 62 tahun, dengan riwayat stroke iskemik berulang dan kelemahan tungkai kiri direncanakan untuk CEA dengan anestesi umum. Ahli bedah memutuskan untuk menggunakan shunt secara selektif dengan menilai monitoring EEG saat dilakukan clamping. Akhirnya shunt tidak jadi dilakukan, operasi berjalan selama 6 jam, diwarnai dengan gejolak hemodinamik yang sering terjadi pada pasien dengan penyakit karotis akibat gangguan baroreseptor. Dengan penanganan anestesi yang cermat selama dan sesudah operasi, operasi berhasil dilakukan, dan hasil postoperasi kekuatan motorik kaki kiri meningkat dari 2 ke 4.Management Neuroanesthesia for Carotid Endarterectomy: Patients with a History of Recurrent StrokeAbstractCarotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.

Strategi untuk Mencegah Aspirasi Isi Lambung pada Operasi Cedera Otak Otak Traumatika Emergensi Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Pengelolaan pasien emergensi memiliki tantangan tersendiri bagi anestesiologis. Resiko terjadinya aspirasi isi lambung sangat besar pada pasien emergensi. Angka kejadian aspirasi isi lambung pada pasien emergensi berkisar antara 0,7-4% yang dapat berakibat kematian. Disfungsi gastrointestinal sering terjadi pada pasien dengan cedera otak traumatika. Lebih dari 50% pasien dengan cedera kepala berat tidak mentoleransi enteral feeding. Intoleransi ini manifest dengan adanya muntah, distensi abdominal, pelambatan pengosongan lambung, refluks oesofageal dan penurunan peristaltik intestinal, yang menunjukkan bahwa disfungsi gastrointestinal adalah fenomena yang umum setelah cedera otak traumatika. Puasa merupakan pencegahan yang efektif untuk mengurangi terjadinya resiko aspirasi isi lambung, namun pada kasus emergensi sulit untuk dilaksanakan. Berbagai upaya yang dapat dilakukan pada pasien emergensi untuk mengurangi angka kejadian aspirasi adalah: a) pemberian obat-obatan tertentu sebelum dilakukannya anestesi: histamine 2-reseptor antagonis (ranitidine, cimetidine), proton pump inhibitor (omeprazole), antacid (sodium citrate, magnesium trisilicate) dan antiemetic (ondansentrone), b) posisi kepala yang lebih tinggi dari tubuh 30-45o, c) rapid sequence induction dengan sellick maneuver, d) pemasangan pipa naso atau orogastric dan aspirasi isi lambung. Rapid sequence induction tidak memberi kesempatan untuk mencegah kenaikan tekanan darah saat laringoskopi dan intubasi, padahal untuk pasien dengan kelainan serebral termasuk cedera otak traumatika, harus dihindari lonjakan tekanan darah yang akan meningkatkan tekanan intrakranial. Aspirasi isi lambung merupakan komplikasi anestesi yang mungkin terjadi pada periode perioperatif khususnya pada pasien emergensi. Pengelolaan yang adekuat mampu untuk mengurangi terjadinya resiko aspirasi.Strategy to Prevent Gastric Content Aspiration in Emergency Traumatic Brain Injury SurgeryManagement of an emergency patients has a particular challenge for an anesthesiologist. The risk of pulmonary aspiration from gastric content is very high in emergency cases. The incidence of gastric aspiration in emergency cases is approximately 0.7-4% which could lead to death. Gastrointestinal dysfunction frequently occurs in patients with traumatic brain injury (TBI). More than 50% patients with severe head injuries could not tolerate enteral feedings. This intolerance is manifested by vomiting, abdominal distention, delayed gastric emptying, esophageal reflux and decreased intestinal peristalsis, indicating that gastrointestinal dysfunction is a common phenomenon following TBI. Fasting is an effective manouver to reduce the incidence of gastric aspiration, but in emergency cases is rather difficult to establish that manouver. Several manouvers to reduce aspiration incidence are: a) to administer drugs prior to induction: histamine 2-reseptor antagonist (ranitidine, cimetidine), proton pump inhibitor (omeprazole), antacid (sodium citrate, magnesium trisilicate) and antiemetic (ondansentrone), b) head up position of 30-45o, c) rapid sequence induction with sellick manouver, d) insert naso or orogastric tube and aspirate gastric content. By using rapid sequence induction there would be not enough time to avoid the increase in blood pressure during laryngoscopy-intubation, whereas for patient with cerebral disorder including traumatic brain injury, increased blood pressure should be avoided because this will lead to increase intracranial pressure. Gastric content aspiration is one of anesthesia complication during perioperative periode especially in emergency cases. Adequate managment can reduce the incidency of aspiration.

Deep Vein Thrombosis (DVT) Pasca Cedera Otak Traumatik Berat Martaria, Nency; Fuadi, Iwan; Sudadi, Sudadi
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
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Cedera otak traumatik(COT) adalah penyebab utama kematian dan disabilitas. Deep vein thrombosis (DVT) adalah salah satu risiko tinggi dari COT. Faktor risiko DVT lain yang umum ditemukan pada pasien COTadalah paralisis, imobilisasi, dan cedera ortopedi. Deep vein thrombosis diduga terkait gangguan koagulasi yang sering ditemukan pada COT, terutama pada COT berat. Deep vein thrombosis dapat menyebabkan pulmonary embolism (PE) yang merupakan salah satu penyebab kematian lambat terbanyak pada pasien trauma. Diagnosis DVT didapatkan melalui stratifikasi risiko, pemeriksaan fisik, dan pemeriksaan penunjang yang mencakup pemeriksaan d-dimer, ultrasonografi, dan penunjang lain seperti spiral computed tomography venography. Tata laksana DVT pada pasien COT mencakup pemberian antikoagulan intravena yang dilanjutkan oral jangka panjang,stoking kompresi, dan pemasangan vena cava filter (VCF). Pada pasien COT, adanya risiko perdarahan intrakranial umumnya menimbulkan keraguan pada klinisi terkait inisiasi profilaksis farmakologis dengan antikoagulan. Profilaksis nonfarmakologis mencakup penggunaan graduated compression stocking (GCS), alat kompresi pneumatik (pneumatic compression devices/PCD), A-V foot pump, dan vena cava filter (VCF). Beberapa studi terkini menyarankan pemasangan PCD pada semua pasien COT pada awal perawatan selama tidak ditemukan kontraindikasi. Pemeriksaan CT selanjutnya dilakukan setelah 24 jam. Penemuan hasil yang stabil pada CT, profilaksis farmakologis dapat dimulai dalam 24-48 jam setelah CT. Selama pemberian antikoagulan, CT serial dapat dilakukan untuk memantau progresi perdarahan.Deep Vein Thrombosis (DVT) after Severe Traumatic Brain InjuryAbstractTraumatic brain injury (TBI) is a risk factor for deep vein thrombosis (DVT). Beside the common risk factors of DVT among TBI patients, this is associated with coagulopathycommonly foundin TBI, especially in severe TBI.Diagnosis and treatment of DVT are also crucial to prevent mortality. Deep vein thrombosis could be diagnosed through risk stratification, physical examination, and d-dimer as well as ultrasonography examination. Treatment includes intravena anticoagulant continue with longterm oral, stocking compression and the use of vein cava filter (VCF). Deep vein thrombosis could cause pulmonary embolism (PE), a common cause of late mortality in trauma patients. Deep vein thrombosis could be prevented pharmacologically (with anticoagulant) and nonpharmacologically. However, in TBI patients, the risk of intracranial hemorrhage usually considered an initiation of pharmacological prophylaxis. Nonpharmacological prophylaxisincludes graduated compression stocking (GCS), pneumatic compression devices (PCD), A-V foot pump, and vena cava filter (VCF). Latest studes suggest the use of PCD for all TBI patients without contraindication since administration. Computed tomography should be performed within 24 hours and if the resultis stable, pharmacological prophylaxis should be initiated within 24-48 hours.

Perbandingan Mannitol 20%, NaCl 3% dan Natrium Laktat Hipertonik terhadap Osmolaritas dan Brain Relaxation Score Pasien Tumor Otak yang menjalani Kraniotomi Pengangkatan Tumor Wirawijaya, Dear Mohtar; Sitanggang, Ruli Herman; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Mannitol membuat relaksasi otak, namun memiliki efek samping berkurangnya volume intravaskuler, peningkatan kembali tekanan intrakranial (rebound) dan gagal ginjal. Penggunaan NaCl 3% dan natrium laktat hipertonik dapat memberikan relaksasi otak yang baik. Tujuan penelitian ini untuk mengetahui peningkatan osmolaritas dan brain relaxation score (BRS) pada pasien yang menjalani kraniotomi pengangkatan tumor dengan menggunakan mannitol 20%, NaCl 3%, dan matrium laktat hipertonik.Subjek dan Metode: Penelitian merupakan uji klinik terkontrol secara acak terhadap 39 pasien tumor otak yang masing-masing mendapatkan 2,5cc/kgBB mannitol 20%, NaCl 3%, dan natrium laktat hipertonik. Hasil: Tidak ada perbedaan peningkatan osmolaritas yang signifikan antara ketiga kelompok 1 jam setelah pemberian osmoterapi dan saat durameter dibuka (p0,05). BRS pada ketiga kelompok memiliki nilai median yang sama besar (2,00), artinya tidak ada perbedaan BRS yang bermakna (p0,05). Terdapat peningkatan diuresis yang signifikan pada pemberian mannitol 20%, peningkatan klorida pada NaCl 3% dan peningkatan glukosa signifikan pada natrium laktat hipertonik. Simpulan: Mannitol 20%, NaCl 3%, dan natrium laktat hipertonik memberikan relaksasi otak yang sama dan tidak mengakibatkan perbedaan osmolaritas yang signifikan.Comparison Between 20% Mannitol, 3% NaCl and Hypertonic Sodium Lactate on Osmolarity and Brain Relaxation Score Brain Tumor Patient underwent Craniotomy Tumor RemovalBackground and Objective: Mannitol produce brain relaxation but associated with several side effects such as reduced intravascular volume, rebound in intracranial pressure and kidney failure. The use of 3% NaCl and hypertonic sodium lactate (HSL) may provide brain relaxation. Aim of this study is to examine increased osmolarity and brain relaxation score (BRS) in patient underwent craniotomy using 20% mannitol, 3% NaCl, and hypertonic sodium lactate.Subject and Method: This is a randomized control study of 39 brain tumor patients divided into three groups each obtained 2.5cc/kg 20% mannitol, 3% NaCl, and HSL. Result: there is no significant difference of osmolarity between the three groups 1 hour after administration of osmotherapy and during the opening of durameter (p0,05). BRS between the three groups have an equivalent median score (2,00), it means no significant difference in BRS (p0,05). A significantly increased diuresis in the administration of 20% mannitol, increased chloride to 3% NaCl and significant glucose increase in HSL. Conclusion: Administration of 20% mannitol, 3% NaCl and HSL produce the same brain relaxation and resulted in insignificant osmolarity differences.

Luaran Pasien Dengan Perdarahan Intraserebral dan Intraventrikular yang Dilakukan Vp-Shunt Emergensi Jasa, Zafrullah Kany; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Perdarahan intraventrikuler dan intraserebral merupakan kejadian akut yang dapat timbul spontan terutama akibat hipertensi dan aneurisma yang pecah atau oleh karena cedera kepala akibat trauma. Pada keadaan akut tindakan yang dilakukan dapat berupa pemberian obat-obatan ataupun tindakan pembedahan. Tindakan pembedahan yang dilakukan bertujuan untuk mengurangi tekanan intrakranial yang meningkat mendadak dan mengeluarkan hematoma untuk segera memperbaiki gangguan fungsi dan mencegah kerusakan neurologis lebih berat. Tindakan ini diharapkan dapat menurunkan tekanan intrakranial serta mengurangi resiko timbulnya hidrosefalus akibat tersumbatnya sistem ventrikel di otak sebagai salah satu kompilkasi dari perdarahan intrakranial.Subjek dan Metode: Telah dilakukan tindakan pemasangan Ventrikulo-Peritoneal Shunt (VP-Shunt) pada 8 orang pasien yang mengalami perdarahan intraventrikuler atau perdarahan intraserebral oleh karena stroke dan trauma dalam 72 jam pertama setelah timbulnya gejala. Dilakukan perbandingan terhadap GCS awal sebelum operasi dan 72 jam setelah operasi serta luaran terhadap pasien terebut.Hasil: Didapatkan bahwa 6 orang pasien (75%) terjadi peningkatan GCS setelah pemasangan VP-Shunt. Dari pasien yang mengalami perbaikan GCS didapatkan selanjutnya 4 orang (50%) dipulangkan dan 4 pasien meninggal selama perawatan karena komplikasi.Simpulan: Tindakan VP-Shunt pada keadaat akut terhadap pasien perdarahan intraventrikuler dan intraserebral diduga dapat memperbaiki tingkat kesadaran meskipun luaran pasien tidak menunjukkan perbedaan bermaknaOutcome of Patients with Intracerebral and Intraventricular Haemorrhage After an Emergency Vp-Shunt Insertion Background and Objective: Intraventricular and intracerebral haemorrhage is an acute condition that can occurs spontaneously due to hypertension or rupture of aneurism, and also can be occurs as a result from brain damage caused by trauma. Management in this acute condition can be done by either giving particular drugs or through surgical procedures. The aim of surgical procedure is to reduce a sudden increase of intracranial pressure as well as to evacuate hematome, in order to prevent functional neurology disturbance and damage. By performing this management, intracranial pressure is expected to decrease, and to reduce the risk of hydrocephalus resulted from an occlusion in brain ventricular system as one of the complication of intracranial haemorrhage.Subject and Method: Ventriculo-Peritoneal Shunt (VP-Shunt) was inserted during the first 72 hours after the event in 8 patients with intraventricular and intracerebral haemorrhage due to stroke and trauma. Level of consciousness was assessed, by comparing the pre-operative and 72 hours post-operative using Glasgow Coma Scale (GCS), and the patient outcome was also assessed.Result: Six (75%) patients showed an increase GCS after VP-Shunt insertion, with 4 of them can be discharged from the hospital, whilst 4 patients died due to other complications.Conclusion: VP-Shunt insertion in acute condition in patients with intraventricular and intracerebral haemorrhage is considered to be useful in accelerating the level of consciousness, even though the overall outcome of the patients is not significantly different.

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Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

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

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Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

Phone
+6287722631615

Journal Mail Official
jni@inasnacc.org

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

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INDONESIA