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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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Tatalaksana Anestesi Pasien Adenoma Hipofisis dengan Riwayat Hipotiroid Maharani, Nurmala Dewi; Bisri, Dewi Yulianti; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
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Adenoma hipofisis merupakan tumor otak dengan gejala klinis tergantung hormon yang dihasilkan oleh sel tumor, ukuran, dan invasi lokal. Perempuan 50 tahun dengan adenoma hipofisis dengan riwayat hipotiroid. Pada pemeriksaan prabedah GCS E4M6V5, tekanan darah 114/76 mmHg, denyut nadi 81x/menit, pernafasan 18x/menit, dan saturasi 99%. Pada pemeriksaan fisik berat badan dan visus mata kanan menurun. Pemeriksaan fungsi tiroid kesan hipotiroid, lalu pasien diterapi levotiroksin natrium 100 g perhari tablet selama 14 hari sampai dengan eutiroid. Tatalaksana lanjutan yang dilakukan adalah kraniotomi reseksi adenoma hipofisis. Premedikasi hidrokortison 100 mg dan midazolam 0,1mg/kgbb intravena. Induksi propofol 1 mg/kgbb, fentanyl 2g/kgbb, rocuronium 1 mg/kgbb, lidokain 1 mg/kgbb dan propofol pengulangan dosis 0,5 mg/kgbb. Manitol diberikan 0,5 mg/kgbb dan dexamethason 10 mg. Rumatan anestesi sevoflurane 0,5% dan propofol 50100 g/kgbb/menit. Pasca operasi pasien di ICU diberikan dexmedetomidine 0,2 g/kgbb/jam dan suplemen steroid H-1 diberikan 25 mg hidrokortison setiap 12 jam. Pada H-2 diberikan 20 mg hidrokortison pagi hari dan 10 mg sore hari kemudian dapat dihentikan. Pasien dirawat di ICU 3 hari sebelum pindah ruang rawat biasa. Manajemen perioperatif adenoma hipofisis dengan riwayat hipotiroid adalah mengoptimalkan pra operasi pasien sehingga pasien mencapai eutiroid, menjaga stabilitas hemodinamik, mengoptimalkan oksigenasi serebral, mencegah serta mengatasi komplikasi.Anesthesia Management of Patient with Pituitary Adenoma with Hystory of HypothyroidismAbstractPituitary adenoma is a brain tumor has clinical symptoms depending on hormones produced by tumor cells, size, and local invasion. A 50-year-old woman with pituitary adenoma with history of hypothyroidism. On preoperative, GCS E4M6V5, blood pressure was 114/76 mmHg, pulse was 81x/minute, respiration was 18x/minute, and saturation was 99%. On physical examination, body weight and the visual acuity in the right eye decreased. Examination of thyroid function suggests hypothyroidism before surgery, patient was treated with levothyroxine sodium 100 g per day tablets for 14 days until euthyroid. The next treatment was resection craniotomy of the pituitary adenoma. Premedicated with hydrocortisone 100 mg and midazolam 0.1 mg/kg body weight. Induction propofol 1 mg/kg body weight, fentanyl 2 g/kg body weight, rocuronium 1 mg/kg body weight, lidocaine 1 mg/kg body weight and repeated doses of 0.5 mg/kg body weight propofol. Mannitol was given 0.5 mg/kgbw and dexamethasone 10 mg. Maintenance anesthesia with sevoflurane 0.5% and propofol 50-100 g/kgbw/min. Postoperative the patient in the ICU was given dexmedetomidine 0.2 g/kgbw/hour and steroid supplement day-1 was given 25 mg hydrocortisone every 12 hours. On day-2, 20 mg of hydrocortisone in the morning and 10 mg in the evening, then can be discontinued. The patient was admitted to the ICU for 3 days before moving to the ward. Perioperative management of pituitary adenoma with a history of hypothyroidism is optimizing preoperatively the patient reaches euthyroid, maintaining hemodynamics, optimizing cerebral oxygenation, preventing and treatment if there are complications.

Awake Craniotomy: Pengalaman dengan Dexmedetomidin Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Awake craniotomy (AC) menggunakan anestesi lokal dan sedasi termonitor untuk mengambil tumor intrakranial yang mengenai eloquent cortex merupakan teknik yang telah diterima. Teknik ini memungkinkan dilakukan pemetaan intraoperatif yang memfasilitasi reseksi tumor secara radikal dan meminimalkan morbiditas dengan mempertahankan jaringan yang berfungsi. Kebutuhan pemetaan cortex adalah untuk menggambarkan fungsi otak, seperti bicara, sensoris, dan motoris dengan tujuan untuk mempertahankannya selama dilakukan reseksi. Obat yang diberikan harus dapat memberikan level sedasi dan analgesi yang adekuat untuk mengangkat tulang, tapi tidak mempengaruhi testing fungsonal dan elektrokortikografi. Prosedur sama dengan kraniotomi standar, tapi dengan satu perbedaan-pasien sadar penuh selama pemetaan korteks dan reseksi tumor. Pasien mampu bicara dan bergerak normal. Pasien tidak selalu bangun selama pembedahan, tapi tidur dalam 12 jam pertama dan atau setelah reseksi tumor. Tidak ada rasa sakit selama sadar. Sasaran anestesi adalah pasien nyaman, mampu tidak bergerak selama pembedahan, sadar dan kooperatif saat pemetaan korteks yang dapat dicapai dengan: 1) persiapan pasien yang adekuat, 2) lingkungan nyaman, 3) pemberian sedatif analgesik yang tepat, 4) selalu berkomunikasi dengan pasien, dan 5) cepat diterapi bila ada komplikasi. Dexmedetomidine adalah suatu a2 adrenoceptor agonist spesifik dengan efek sedatif, analgesik, anesthetic sparring effect, bangun bila distimulasi, efek proteksi otak, tidak adiksi, tidak menekan respirasi. Pasien yang diberikan dexmedetomidin bisa tersedasi dan nyaman tapi mudah dibangunkan dan mentoleransi AC yang berlangsung lama.Awake Craniotomy: Experience with DexmedetomidineAwake craniotomy (AC) using local anesthesia and monitored sedation in intracranial tumor removal involving eloquent cortex has been considered as an acceptable technique. It allows intraoperative mapping that facilitates radical tumor resection while minimizing morbidity by preserving functional tissue. Anesthesia for intracranial procedure requiring patient cooperation present a challange to the anesthesiologist. The need for cortex mapping is to describe brain function, such as verbal, sensoric and motoric aiming for maintain its function during resection. The administered drugs should provide an adequate level of sedation and analgesia for bone flap removal, but must not interfere with functional testing and electrocorticography. The procedure is very similar to a standard craniotomy, but with one difference-the patient is fully awake during cortical mapping and tumor resection. Patient is able to talk and move normally. The patient should not awake during surgery, but is in deep sleep for the first 1-2 hours and/or after tumor resection. There will be be no pain during conscious time. The goal of anesthesia is patients comfort, able to stay immobile on OR table during the procedure, and is alert and cooperative to comply with cortical mapping. These goals can be accomplished by 1) adequate preparation of the patients, 2) a comfortable environment, 3) appropriate administration of right analgetic and sedative medication, 4) conduct ongoing communication, 5) perform rapid treatment to any complications. Dexmedetomidine is a highly spesific a-2 adrenoceptor agonist with sedative, analgesic, anesthetic sparring effect, awake if stimulated, brain protection with no addiction effect nor suppress ventilation. Patients treated with dexmedetomidine will be sedated, comfortably but is easily aroused to tolerate a prolonged awake craniotomy.

Pertimbangan Anestesi Perioperatif untuk Pasien Bedah Saraf dengan Covid-19 Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Coronavirus yang baru, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pertamakali timbul di Wuhan, Provinsi Hubei Cina, pada bulan Desember 2019, dan menyebar dengan cepat ke seluruh dunia ke lebih dari 190 negara. Pasien harus ditapis untuk covid-19 menggunakan kombinasi riwayat penyakit, computed tomography (CT) dada, dan pemeriksaan real time quantitative polymerase chain reaction (RT-qPCR) bergantung kebijakan institusinya. Keluhan neurologis seperti dizziness, headache, hypogeusia dan hyposmia, sering (36%) pada pasien covid-19. Encefalopati dan perubahan status mental juga terjadi pada pasien yang telah terinfeksi dengan virus SARS-CoV-2. Penyakit serebrovaskuler lebih sering pada covid-19 yang berat; acute ischemic stroke telah dilaporkan pada 5,7% dan gangguan kesadaran pada 15% pasien. Tindakan pembedahan rutin kranial dan spinal aman untuk dilakukan. Operasi endoscopic endonasal tidak aman dan harus dihindari. Ekstubasi setelah anestesi umum bila memungkinkan dilakukan di ruangan tekanan negatif, personil tetap memakai alat pelindung diri (APD) level 3. Harus dihindari pasien batuk saat ekstubasi. Setelah ekstubasi, pasang oksigen binasal, dan pasien harus memakai masker bedah dan aliran oksigen tinggi harus dihindari (berikan 6L/menit) untuk menghindari terjadinya aerosolisasiPerioperative Anesthesia Consideration for Neurosurgical patients with Covid-19AbstractThe novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei province China, in December 2019, and spread fast to all the world more than 190 countries. Patients should be screened for covid-19 using a combination of history, computed tomography (CT) chest, and real time quantitative polymerase chain reaction (RT-qPCR) testing depending on institutional policies. Neurological symptom as dizziness, headache, hypogeusia and hyposmia, common (36%) at covid-19 patient. Encephalopaty and changed mental status exist in patient infected by SARS-CoV-2 virus. Cerebrovascular diseases more in severe covid-19; acute ischemic stroke had reported in 5.7% and altered level of consciousnes in 15% patient. Surgical measuremet cranial and spinal rutine is safe, endoscopic endonasal surgery not safe and must be avoided. Extubation after general anesthesia if possible do air negative pressure room, and personil still use personal protection equipment (PPE) level 3. Must be avoid patient cough during extubation. After extubation, give oxygen nasal canule, surgical mask, and high flow oxygen (give 6 L/min) avoided given the risk of aerosolization

Perioperatif Anestesi Pada Kraniotomi Penderita Cedera Otak Berat Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Cedera otak traumatik (TBI) merupakan penyebab kematian dan kecacatan pada penderita, apabila tidak mendapatkan pertolongan yang cepat dan tepat. Diperlukan peran seorang ahli anestesi dalam hal penanganan, yang dimulai sejak pra rumah sakit sampai perawatan neuro intensif. Standar terapi cedera otak traumatik selalu mengalami kemajuan dari tahun ke tahun, yang diharapkan bisa mencapai hasil yang maksimal dalam menangani kasus trauma kepala. Seorang laki-laki, usia 37 tahun, berat badan 75 kg, tinggi badan 170 cm. Penderita rujukan dari rumah sakit di kabupaten dengan diagnosa cedera otak berat. Mulai dari kejadian sampai masuk kamar operasi membutuhkan waktu 12 jam. Terjadi penurunan GCS dari 11 (3,3,5) ke 8 (2,2,4) kemudian 7 (1,2,4) dan dilakukan intubasi di ruang resusitasi, sebelum masuk kamar operasi. Dilakukan kraniotomi selama 7 jam untuk evakuasi hematoma subdural. Setelah operasi, dilakukan monitoring tekanan intrakranial (ICP) dan tindakan untuk terapi hipertensi intrakranial. Hari ketiga post operasi dilakukan tracheostomi. Hari ke lima post operasi, GCS 2,X,5 (dengan tracheostomi) dan penderita alih rawat ke bangsal. Penanganan penderita cedera otak traumatik seharusnya sudah dilakukan di tempat kejadian trauma dan berkesinambungan sampai perawatan intensif. Dengan adanya petugas trauma care yang terlatih di setiap daerah, diharapkan tidak terjadi keterlambatan dalam penanganan penderita yang juga akan berdampak pada hasil akhir penderita. Pemilihan obat anestesi disesuaikan dengan situasi dan kondisi penderita, termasuk kondisi rumah sakit. Semua itu mempunyai tujuan utama untuk mencegah kerusakan sekunder, serta diharapkan akan mengurangi mortalitas dan kecacatan penderita trauma.Perioperative Anesthesia In Craniotomy For Severe Traumatic Brain InjuryTraumatic brain injury (TBI) is a major cause of death and dissability in patient, if it doesnt get any therapy quickly and accurately. Anesthesiologist is important in case to handling the therapy from the accident site until in the neuro intensive care. A standard therapy in TBI is always moving forward by years, that is expected to achieve maximal results in that case. A man, 37 years old, weight 75 kg, height 170 cm. This patient was referral from another hospital in counties with severe head injury. Takes 12 hours, from the accident event until the patient arrive in the operating room. GCS is continues to drop from 11( 3,3,5) to 8 (2,2,4) and became 7 (1,2,4) then the intubation is taking place in the resuscitation room, before the patient get into the operation room. Craniotomy was done in 7 hours to evacuate subdural hematoma. After surgery, ICP monitoring and intracranial hypertension therapy was taken. In the 3rd day after surgery, tracheostomy was given to the patient. In the 5th day after main surgery, GCS is 2, X, 5 (with tracheostomy) and move to ward. The treatments of patient with TBI should taken on the site of accident until the patient in intensive care unit. A trained emergency staff in every region is expected in patient management effectively, that can affect in final results. The selection of anesthesia agent is depends on both patient and hospital, condition and circumstances. All of it, has a primary purpose to prevent secondary damage and expected to reduce mortality and disability in patients.

Cedera Medulla Spinalis Akibat Fraktur Vertebra Cervical 5 6 Gaus, Syafruddin; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Cedera medulla spinalis akut merupakan penyebab yang paling sering dari kecacatan dan kelemahan. Penyebab utama cedera medulla spinalis adalah trauma, dimana insidensinya pada laki-laki 5 kali lebih besar daripada perempuan. Laki-laki, 25 tahun, Berat Badan 50 kg, Tinggi Badan 160 cm. Pasien dikonsulkan ke Bagian Anestesi dengan paraplegia disebabkan karena fraktur vertebra C5-6 pro dekompressi dan stabilisasi posterior. Tanda vital: Tekanan Darah 120/60 mmHg; laju nadi 78 x/menit, reguler, kuat angkat; laju napas 18 x/menit, tipe abdominal; suhu afebris; dan VAS = 1/10. Penanganan cedera medulla spinalis, dimulai pada saat evaluasi awal, dimana terjaminnya jalan nafas menjadi prioritas utama, oksigenasi dan ventilasi yang adekuat, dan dilanjutkan dengan terapi untuk mencegah ataupun mengatasi komplikasi yang terjadi.Spinal Cord Injury Cause By Vertebra Cervical 5-6 FractureAcute spinal cord injury is common cause for weakness and morbidity. The primary cause of spinal cord injury is trauma, high incidency at man 5 time higher than woman. A man, 25 years old, body weight 50 kg, height 160 cm has been consulted to Department of Anesthesiology with paraplegia cause by vertebrae C5-6 fracture pro decompression and posterior stabilization. Vital sign: blood pressure 120/60 mmHg, heart rate 78/minute, regular, adequate volume, respiratory rate 18/minute, abdominal, temperature afebris, and VAS 1/10. The management of spinal cord injury, started in early evaluation, with the primary priority is airway, oxygenation, and adequate ventilation, and continuous with therapy for avoiding and treatment the complication.

Pengelolaan Hipertensi Intrakranial yang Membandel pada Cedera Otak Traumatik Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
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Hipertensi intrakranial yang membandel (intractable/refracter/malignant intracranial hypertension) didefinisikan sebagai peningkatan tekanan intrakranial (intracranial pressure/ICP) lebih dari 25 mmHg selama 30 menit, 30 mmHg selama 15 menit, atau 40 mmHg selama 1 menit. Definisi lain adalah peningkatan ICP sebagai peningkatan spontan ICP 20 mmHg selama 15 menit dalam periode 1 jam meskipun telah dilakukan intervensi first-tier secara optimal atau ICP 25 mmHg untuk 1-12 jam. Hipertensi intrakranial adalah kelainan yang dapat berakibat fatal. Mortalitas tertinggi dari hipertensi intrakranial terlihat pada pasien dengan cedera kepala berat, yang mana peningkatan ICP sangat ekstrim dan sering membandel terhadap terapi. Masalah utama peningkatan ICP adalah iskemia dan herniasi.Tindakan untuk terapi hipertensi intrakranial adalah pasang monitor ICP, pertahankan cerebral perfusion pressure (CPP) 50-70 mmHg, first-tier therapy dan second-tier therapy. Indikasi pemasangan monitor ICP adalah 1) abnormal CT scan dan skor GCS 3-8 setelah dilakukan resusitasi yang adekuat untuk syok dan hipoksia, 2) normal CT scan dan skor GCS 3-8 disertai dengan 2 atau lebih hal-hal berikut: umur 40 tahun, posturing, atau tekanan darah sistolik 90 mmHg. Terapi untuk menurunkan ICP dimulai pada level ICP 20-25 mmHg. First-tier therapy untuk terapi peningkatan tekanan intrakranial adalah: 1) CSF drainase melalui kateter intraventricular, 2) diuresis dengan mannitol, 0,25-1,5 g/kg berikan lebih 10 menit, 3) moderate hiperventilasi.Bila tekanan intrakranial membandel terhadap first-tier therapy (intractable) lakukan second-tier therapy yaitu hiperventilasi untuk mencapai PaCO2 30 mmHg (dianjurkan memasang monitor SJO2, AVDO2, dan/atau CBF), dosis tinggi terapi barbiturat, hipotermia, terapi hipertensif, dekompresif kraniektomi.The Management of Intractable Intracranial Hypertension in Traumatic Brain InjuryIntractable intracranial hypertension (refractory/malignant intracranial hypertension) defined as intracranial pressure (ICP) that exceed 25 mmHg for 30 minutes, 30 mmHg for 15 minutes, or 40 mmHg for 1 minute. Other definition are refractory elevation in ICP as a spontaneous increase ICP 20 mmHg during 15 minutes within a 1 hour period despite optimized first-tier intervention or ICP 25 mmHg for 1-12 hour. Intracranial hypertension is a potentially fatal disorder. The highest mortality from intracranial hypertension is seen in patient with severe head injury, in whom elevations in intracranial pressure are extreme and frequency resistant to treatment. Main problem of increased intracranial pressure (ICP) are ischemia and herniation.Treatment of intracranial hypertension includes insert ICP monitor, maintenance CPP 50-70 mmHg, first-tier therapy and second-tier therapy. Indication for insertion of an ICP monitor include 1) an abnormal CT scan and a GCS score of 3 to 8 after adequate resuscitation of shock and hypoxia, 2) normal CT scan and a GCS of 3 to 8 accompanied by two or more the following at admitted hospital: age 40 years, posturing, or systolic blood pressure of 90 mmHg. Treatment to decrease ICP usually initated at ICP level of 20-25 mmHg. The aim is to maintain CPP 50-70 mmHg. First-tier therapy involves the following: 1) incremental CSF drainage via an intraventricular catheter, 2) diuresis with mannitol, 0.25-1.5 g/kg over 10 minutes, 3) moderate hyperventilation. If intracranial hypertension intractable to first-tier therapy, do second-tier therapy: hyperventilation to achieved PaCO2 30 mmHg (SJO2, AVDO2, and/or CBF monitoring is recommended), high dose barbiturate therapy, consider hypothermia, consider hypertensive therapy, consider decompressive craniectomy.

Anestesi untuk Malformasi Arnold Chiari Arianto, Ardana Tri; Sudjito, M.H
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Malformasi Arnold-Chiari, merupakan suatu bentuk malformasi pada otak. Pada malformasi ini terjadi pergeseran (displasi) tonsila serebelum ke arah bawah melalui foramen magnum (lubang di basis kranii), yang terkadang menyebabkan hidrosefalus non-komunikans sebagai akibat terjadinya obstruksi aliran keluar dari cairan serebrospinal. Seorang wanita 23 tahun datang dengan keluhan sering pusing, nyeri tengkuk, serta kelemahan pada lengan kanan. CT Scan dan MRI didapatkan gambaran cerebellar tonsil yang mendukung Arnold Chiari Malformation. Dilakukan operasi osteotomi suboccipital dengan posisi prone. Rumatan anestesi dengan sevoflurane 1 vol% dan O2: udara 1,5: 1,5, analgetik fentanyl 25 mcg tiap 30 menit, pelumpuh otot vecuronium 3 mg/jam. Operasi berlangsung selama 2 jam 45 menit. Hemodinamik selama operasi stabil. Dilakukan ekstubasi segera di kamar operasi. Pascaoperasi pasien dirawat di unit intensif selama sehari. Hemodinamik selama di ICU stabil. Tidak ada keluhan selama di ICUAnesthesia for Arnold Chiari MalformationArnold-Chiari's malformation, is a brain malformation caused by the displacement of the cerebellar tonsil caudally into the foramen magnum, which in some cases will cause obstruction of the cerebrospinal fluid flow, resulting in a communicating hydrocephalus condition. A 23 years old female patient with a chief complaint of having frequent dizzines, painful neck, and weakness of the right arm. CT scan and MRI reveal cerebellar tonsil imaging that support the diagnosis of Arnold-Chiari's malformation. Surgical procedure was performed using suboccipital osteotomy approach in a prone position. Maintenance anesthesia with sevoflurane 1 vol% and O2: air 1,5: 1,5, analgetic fentanyl 25 mcg every 30 minute, muscle relaxant vecuronium 3 mg/hour. The time of surgery was 2 hours and 45 minutes. Hemodynamics were stable during the procedure. Patient was extubated early after surgery at operating room, and admitted to the ICU for 24 hours. Hemodynamics parameter were stable, without any remarkable events.

Karakteristik Klinis dan Status Nutrisi pada Pasien Stroke Fase Akut Amalia, Lisda; Putri, Arviana Adamantina
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Disabilitas yang berat pada stroke meningkatkan risiko terjadinya malnutrisi. Malnutrisi pada pasien stroke dapat disebabkan oleh defisit neurologis dan faktor risiko. Malnutrisi pada stroke meningkatkan morbiditas dan mortalitas. Penelitian ini bertujuan untuk mengetahui karakteristik klinis dan status nutrisi pasien stroke.Subjek dan Metode: Penelitian bersifat deskriptif retrospektif pada pasien stroke yang dirawat di RSUP Hasan Sadikin Bandung pada periode 1 Agustus 2020 hingga 30 September 2020. Status nutrisi dinilai menggunakan Indeks Massa Tubuh (IMT) dan skor Subjective Global Assessment (SGA). IMT dihitung menggunakan kg/m2, dikelompokkan menjadi obesitas (IMT 30), overweight (IMT 25,029,9), normal (IMT 18,524,9) dan underweight (IMT 18,5). Skor SGA 2 termasuk nutrisi baik, dan ?2 tergolong malnutrisi.Hasil: Didapatkan 52 orang pasien stroke yang sebagian besar berjenis kelamin laki-laki (57,7%) dengan rentang usia 3886 tahun (rata-rata 57 tahun), 51,9% mengalami malnutrisi berdasarkan skor SGA, IMT normal dan overweight sebanyak 23 (44,2%) orang, diikuti obesitas (5,7%) dan underweight (5,7%). Ditemukan 71,4% usia ?65 tahun mengalami malnutrisi. Kondisi malnutrisi didominasi pasien stroke infark kardioemboli (63,6%), dengan derajat stroke berat (58,3%), disfagia (59,4%), dengan komorbid infeksi (71,4%) dan stress ulcer (55,6%).Simpulan: Berdasarkan penelitian ini, didapatkan bahwa usia tua , derajat stroke sedang-berat, komorbid infeksi dan stress ulcer akan memiliki kecenderungan malnutrisi sehingga penanganan stroke yang baik dapat menurunkan risiko terjadinya malnutrisi. Kejadian stroke berulang tidak menjadi risiko terjadinya malnutrisi pada penelitian ini.Clinical Characteristics and Nutrition Status in Acute Stroke PatientsAbstractBackground and Objective: Severe disability in stroke increase the risk of malnutrition. Malnutrition in stroke patients can be caused by neurological deficits and risk factors. Malnutrition in stroke increases morbidity and mortality. This study aims to determine the clinical characteristics and nutritional status of stroke patients.Subject and Methods: This study was a retrospective descriptive study of stroke patients who were treated in the Neurology ward of Hasan Sadikin Hospital Bandung from 1 August 2020 to 30 September 2020. Nutritional status was assessed using Body Mass Index (BMI) and Subjective Global Assessment (SGA) scores. BMI was calculated using kg/m2, grouped into obese (BMI 30), overweight (BMI 25.0-29.9), normal (BMI 18.5-24.9) and underweight (BMI 18.5). SGA score 2 is considered as good nutrition, and ?2 is classified as malnutrition.Results: There were 52 stroke patients, most of them were male (57.7%) with an age range of 38-86 years old (mean 57 years), 51.9% were malnourished based on the SGA score, normal BMI and overweight were 23 (44.2%) people, followed by obesity (5.7%) and underweight (5.7%). We also found 71.4% aged ?65 years are malnourished. This condition was dominated by cardioembolic stroke patients (63.6%), with severe stroke (58.3%), dysphagia (59.4%), with comorbid infections (71.4%) and stress ulcers (55.6%).Conclusion: Based on this study, it was found that elderly, moderate-severe stroke, comorbid infections and stress ulcers have a tendency related to malnutrition. Good or better management can/indeed reduce the risk of malnutrition. Stroke history was not a risk for malnutrition in this study.

Patofisiologi Serebrovaskuler dan Implikasi Anestesi pada Preeklampsia/Eklampsia Septica, Rafidya Indah; Uyun, Yusmein; Suryono, Bambang
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Preeklampsia adalah kelainan multisistim unik pada ibu hamil. Preeklampsia terjadi pada sekitar 3-8% kehamilan, dengan angka mortalitas akibat gangguan serebrovaskuler yang cukup tinggi (67%). Adanya 2 protein antiangiogenik yang diproduksi berlebihan oleh plasenta yang memberi akses masuk ke sirkulasi maternal merupakan molekul yang bertanggung jawab terhadap munculnya preeklampsia, yaitu soluble Fms-like tyrosine kinase, yang merupakan inhibitor endogen vascular endothelial growth factor dan placental growth factor, dan endoglin terlarut (sEng). Faktor-faktor tersebut menyebabkan disfungsi endotel sistemik yang berefek terutama ke hati, otak, dan ginjal. Disfungsi endotel pada otak diasumsikan berperan melalui 2 teori, yaitu sebagai respon terhadap hipertensi berat akut, sehingga regulasi berlebihan serebrovaskuler memicu terjadinya vasospasme; dihipotesakan aliran darah otak (ADO) hilang akibat iskemia, edema sitotoksik, infark dan terjadinya peningkatan mendadak tekanan darah sistemik melebihi kapasitas autoregulasi serebrovaskuler normal, sehingga terjadi kerusakan tekanan ujung kapiler yang menyebabkan kenaikan tekanan hidrostatik, hiperperfusi, ekstravasasi plasma dan sel darah merah melalui endothelial tight junctions yang terbuka mengakibatkan akumulasi edema vasogenik. Walaupun demikian perubahan serebrovaskuler tidak selalu menyebabkan peningkatan tekanan intrakranial. Dengan bantuan teknologi yang lebih baik dan canggih, abnormalitas serebrovaskuler yang dipicu oleh preeklampsia-eklampsia, juga efek hipertensi pada perfusi serebral dapat dijelaskan dengan lebih baik. Pertimbangan khusus pemilihan teknik anestesi pada preeklampsia dimulai dengan persiapan preoperatif berupa penilaian preanestesi, pemilihan manajemen anestesi, teknik induksi pada anestesi umum, dan interaksi antara MgSO4 dan pelumpuh otot nondepolarisasi. Teknik anestesi sesuai kaidah neuroanestesi adalah teknik terpilih pada preeklampsia/eklampsia dengan kenaikan tekanan intrakranialCerebrovascular Pathophysiology and Anesthetic Implication in Preeclampsia/EclamsiaPreeclampsia is a uniqe multisystem disorder in pregnant women. Preeclampsia affecting 3-8% of pregnancies, with high maternal mortality related to cerebrovascular accident (67%). The over produced two antiangiogenic proteins by placenta that gain access to the maternal circulation have become the main molecules responsible for phenotype of preeclampsia; which are soluble Fms-like tyrosine kinase, endogenous inhibitor of vascular endothelial growth factor and placental growth factor, and soluble endoglin (sEng). All these factors cause systemic endothelial dysfunction, mostly affected liver, brain, and kidney. Endothelial cell dysfunction may play role in two theories: as respon to acute severe hypertension thus cerebrovascular overregulation leads to vasospasm; as hypothesized,the diminished cerebral blood flow (CBF) resulted in ischaemia, cytotoxic edema, and infarct and a sudden elevation in systemic blood pressure exceeded the normal cerebrovascular autoregulatory capacity, and lead to disruption of the end-capillary pressure which causes increased hydrostatic pressure, hyperperfusion, and extravasation of plasma as well as red cells through disruption of the endothelial tight junctions leading to the accumulation of vasogenic edema. Nevertheless, cerebrovascular changes not always increase intracranial pressure. With the new and better technologies, the abnormal cerebrovascular related to preeclampsia-ecclampsia, and hypertension effect on cerebral perfusion can be more clearly explained. Special consideration for anesthesia technique in preeclampsia should be begin with preoperative preparation as pre-anesthestia assesment, choosing the anesthestia technique, induction technique and consideration of MgSO4 and nondepolarising muscle relaxant interaction when using general anesthesia. If intracranial pressure increased, neuroanesthesia technique is recommended. In preeclampsia/eclampsia cases.

FOUR Score sebagai Alternatif dalam Menilai Derajat Keparahan dan Memprediksi Mortalitas pada Pasien Cedera Otak Traumatik yang Diintubasi Airlangga, Prananda Surya; Hamzah, Hamzah; Santosa, Dhania Anindita; Subiantoro, Andri
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Skala yang mengukur koma yang ideal seharusnya bersifat linear, reliabel, valid, dan mudah digunakan. Berbagai macam skala telah dikembangkan dan divalidasi untuk mengevaluasi tingkat kesadaran secara cepat, derajat penyakit, dan prognosis terhadap morbiditas maupun mortalitas. Glasgow Coma Scale (GCS) merupakan alat pemeriksaan tingkat kesadaran yang paling sering digunakan dan dijadikan gold standard, namun GCS mempunyai keterbatasan karena pasien yang diintubasi tidak dapat dinilai komponen verbal. Full Outline of UnResponsiveness (FOUR) score dikembangkan untuk mengatasi berbagai keterbatasan GCS. Pemeriksaan FOUR score adalah skala penilaian klinis dalam penilaian pasien dengan gangguan tingkat kesadaran. FOUR score lebih sederhana dan memberikan informasi yang lebih baik, terutama pada pasien cedera otak traumatik yang diintubasi. Hasil penelitian menunjukkan bahwa GCS dan FOUR score memiliki nilai prediksi yang tinggi tidak hanya kematian pada pasien trauma tetapi juga luaran pada pasien yang dipulangkan. Studi multicentre menunjukkan FOUR score dan GCS tidak berbeda dalam memprediksi kematian di rumah sakit. Studi tersebut menyarankan bahwa FOUR score dapat menjadi alat diagnostik yang lebih baik untuk menilai refleks batang otak dan pola pernapasan. Namun penelitian lain didapatkan juga hasil yang bertentangan antara GCS dan FOUR score dalam prediksi luaran pasien. Adanya kontradiksi tersebut menunjukkan perlunya dilakukan lebih banyak studi. Oleh karena itu, telaah literatur ini dilakukan dengan tujuan untuk membandingkan skor GCS dan FOUR dalam memprediksi mortalitas pasien trauma.FOUR Score as an Alternative in Assessing the Degree of Severity and Predicting Mortality in Intubated Traumatic Brain Injury PatientsAbstractThe ideal consciousness scoring scale must be linear, reliable, valid, and user-friendly. There is a need to develop and validate a scale to quickly evaluate the level of consciousness, the severity of the disease, and the prognosis of morbidity and mortality. Glasgow Coma Scale (GCS) is the most commonly used tool to assess the level of consciousness and is considered the gold standard. However, GCS has several limitations, such as inability to evaluate verbal components in intubated patients. To overcome these challenges, researchers developed the Full Outline of UnResponsiveness (FOUR) score. FOUR scores is a clinical grading scale to assess the altered state of consciousness. FOUR scores is simpler and able to provide better information, especially in intubated-traumatic brain injury (TBI) patients. Some studies showed that GCS and FOUR scores have the high predictive value in predicting not only the mortality of trauma patients but also the outcome of discharged patients. A multicentre study showed that FOUR scores and GCS do not differ in predicting inpatient mortality. This study suggested that the FOUR scores could be a better diagnostic tool for assessing brainstem reflexes and breathing patterns. Unfortunately, some studies have found conflicting results between GCS and FOUR scores in predicting patient outcomes. These contradictions suggest the need to conduct more studies. Therefore, this literature review will compare GCS and FOUR scores in predicting mortality of TBI patients.

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Contact Name Agni Susanti

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

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Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

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+6287722631615

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jni@inasnacc.org

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

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INDONESIA