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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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Pengelolan Perioperatif Stroke Hemoragik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Stroke hemoragik merupakan penyakit yang mengerikan dan hanya 30% pasien bertahan hidup dalam 6 bulan setelah kejadian. Penyebab umum dari perdarahan intrakranial adalah subarachnoidhemorrhage (SAH) dari aneurisma, perdarahan dari arteriovenous malformation (AVM), atau perdarahan intraserebral. Perdarahan intraserebral sering dihubungkan dengan hipertensi, terapi antikoagulan atau koagulopati lainnya, kecanduan obat dan alkohol, neoplasma, atau angiopati amiloid. Mortalitas dalam 30 hari sebesar 50%. Outcome untuk stroke hemoragik lebih buruk bila dibandingkan dengan stroke iskemik dimana mortalitas hanya sekitar 10-30%. Stroke hemoragik khas dengan adanya sakit kepala, mual, muntah, kejang dan defisit neurologik fokal yang lebih besar. Hematoma dapat menyebabkan letargi, stupor dan koma. Disfungsi neurologik dapat terjadi dari rentang sakit kepala sampai koma. Pengelolaan dini difokuskan pada : 1) pengelolaan hemodinamik dan jantung, 2) jalan nafas dan ventilasi, 3) evaluasi fungsi neurologik dan kebutuhan pemantauan tekanan intrakranial atau drainase ventrikel atau keduanya.Perioperative Management of Hemorrhage StrokeHemorrhagic stroke is devastating disease and only 30% patients survive in 6 months after event. The common cause of intracranial hemorrhage are subarachnoid hemorrhage (SAH) from aneurysm, bleeding from arteriovenous malformation (AVM) or intracerebral hemorrhage. Intracerebral hemorrhage common correlation with hypertension, anticoagulant therapy, or other coagulopathi, drug and alcohol addict, neoplasm, or amyloid angiopathi. Mortality in 30 days is 50%. Outcome for hemorrhagic stroke worst than ischemic stroke with mortality arround 10-30%. Hemorrhagic stroke typically presents with headache, nausea, and vomiting as well as seizure and focal neurological deficits. Neurological dysfunction variated between headache untill coma. Early treatment focused on: 1) hemodynamic and cardiac, 2) airway and ventilation, 3) neurological function evaluation and the needed intracranial pressure monitoring or ventricular drainage or both.

Hubungan Parameter Koagulasi dengan Tipe, Ukuran, dan Jumlah Perdarahan pada Operasi Tumor Otak Supratentorial Sugiyanto, Endy; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Latar Belakang dan Tujuan: Tumor otak memiliki angka kejadian 3,8-5,5% dari semua kasus tumor di Indonesia. Kebanyakan kasus tumor otak mengalami hiperkoagulasi, meskipun terdapat pengecualian pada beberapa kasus. Tujuan penelitian untuk mengetahui hubungan koagulopati dengan tipe, ukuran, dan jumlah perdarahan pada operasi tumor otak supratentorialSubyek dan Metode: Penelitian observasional analitik pada 30 pasien dengan rancangan cross-sectional pengukuran berulang untuk menganalisis hubungan antara koagulopati dengan tipe, ukuran, dan perdarahan tumor otak. Pengambilan sampel penelitian dilakukan secara consecutive samplingHasil: Terdapat 17 orang pasien dengan meningioma, 2 orang pasien dengan oligodendroglioma, 3 orang pasien dengan metastase dan 8 orang dengan tumor lain. Rata-rata bleeding time, clotting time, protrombin time (PT), dan activated partial thromboplastin time (APTT) preoperatif, 2 jam dan 6 jam post operatif berada dalam rentang nilai normal. Ditemukan penurunan yang konstan pada data APTT. Terdapat hubungan negatif yang signifikan antara ukuran tumor dengan bleeding time preoperatif serta hubungan yang signifikan antara jumlah pendarahan dengan APTT preoperatif.Simpulan: Pasien tumor otak mungkin mengalami kondisi hiperkoagulasi dari hasil pemeriksaan faktor koagulasi sederhana, terdapat hubungan negatif antara ukuran tumor dan bleeding time sehingga semakin besar ukuran tumor semakin besar juga risiko hiperkoagulasi yang mungkin dialami pasien.Correlation between Coagulation Parameter and Type, Size, and Blood Loss in Supratentorial Brain Tumor SurgeryAbstractBackground and Objective: The incidence rate of brain tumor 3.8-5.5% of all tumor cases in Indonesia. Most of brain tumor patients experience hypercoagulation, although there are exception in some cases. The purpose of this study to know the relationship between coagulopathy and brain tumor supratentorial type, size, and number of bleeding on operation.Subject and Methods: This is an observational analytical cross-sectional design for 30 patient to analyze correlation between coagulopathy and brain tumor type, size, and bleeding. The sampling methods were consecutive samplingResult: There were 17 patients with meningioma, 2 patients with oligodendroglioma, 3 patients with metastasis and 8 patients with other type of tumor. The average of bleeding time, clotting time, protrombin time (PT), dan activated partial thromboplastin time (APTT) in preoperative, 2 hours and 6 hours were normal. There were constant decline of APTT. Negative correlation between tumor size and preoperative bleeding time and significant correlation between amount of bleeding and preoperative APTT were also found.Conclusion: From simple coagulation factor test result, it is very like for a brain tumor patient to experience hypercoagulative state, a negative correlation between tumor size and bleeding time, meaning the bigger the tumor size, the higer hypercoagulation risk possesed by the patient.

Penatalaksanaan Anestesi pada Pasien Cedera Kepala Berat akibat Hematoma Epidural Akut disertai Kehamilan Aulyan Syah, Bau Indah; Suarjaya, I Putu Pramana; Rahardjo, Sri; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
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Penanganan cedera kepala berat selalu bertujuan untuk mempertahankan tekanan perfusi otak (TPO) dan mencegah peningkatan tekanan intrakranial yang dapat menyebabkan cedera otak sekunder. Pada pasien dengan kehamilan, janin juga harus dipantau. Hiperventilasi harus dihindari karena berefek buruk terhadap perfusi otak dan aliran darah plasenta. Seorang wanita, 25 tahun, 60 kg, 160 cm datang ke rumah sakit akibat trauma kepala karena kecelakaan lalu lintas yang dialami kurang dari 1 jam sebelum masuk rumah sakit dengan GCS E4M6V4. Pasien dalam keadaan hamil G1P0A0 dengan usia kehamilan 2830 minggu. Di unit gawat darurat terjadi penurunan kesadaran mendadak hingga GCS E1M5V1 sehingga dilakukan intubasi endotrakhea disusul dengan pemeriksaan CT Scan dengan hasil hematoma epidural dekstra dan hematoma subarachnoid disertai midline shift. Pasien kemudian menjalani operasi evakuasi hematoma epidural dengan anestesi umum kemudian di rawat di unit perawatan intensif dengan pipa endotrakhea masih dipertahankan. Denyut jantung janin (DJJ) masih terdengar dan dilakukan observasi ketat DJJ selama perawatan di ICU. Namun setelah beberapa hari di ICU, janin dinyatakan meninggal. Ringkasan: Pasien cedera kepala berat dengan hematoma epidural dan subarachnoid disertai kehamilan telah menjalani operasi anestesi umum dengan tetap memperhatikan pemeliharaan tekanan perfusi otak (TPO) dan mempertahankan kondisi janin dalam batas normal. Meskipun pada akhirnya janin tidak bisa diselamatkan akibat lamanya perawatan ibu dengan ventilator.Anesthesia Management for Patients in Pregnancy with Severe Head Injury Due to Acute Epidural Hematoma Management of severe head injury cases, in any given situation, is targeted to maintain cerebral perfusion pressure (CPP), and preventing increase of intracranial pressure that possibly cause secondary brain injury. In a case of pregnancy, besides considering the maternal status, fetus condition is equally important to observe. Hyperventilation should be avoided due to its possible detrimental effect to both the brain perfusion and placental blood flow. A 25 year old female, 60 kg, 160 cm, was taken to the hospital due to head trauma caused by a traffic accident, roughly about an hour prior to hospitalization. GCS was E4M6V4. The patient was in her 28 30 week of pregnancy (G1P0A0). Sudden decrease in consciousness occurred and GCS lowered to E1M5V1. Endotracheal intubation was then prompted. Epidural haematoma subarachnoid haematoma with midline shift revealed in CT scan. The patient underwent epidural hematoma evacuation with general anesthesia then transferred to Intensive Care Unit (ICU) with ETT maintained. Fetal heart rate remains heard, followed with close monitoring of the fetal heart rate during treatment in the ICU. After 3 days in ICU, fetus died. Summary: A pregnant patient with severe head injury of epidural and subarachnoid bleeding, has undergone an operation with general anesthesia. The fetus was unfortunately cannot be saved due to the patient long ventilator treatment.

Penatalaksanaan Anestesi pada Kehamilan dengan Tumor Medula Spinalis Supradnyawati, Ni Made; Suarjaya, I Putu Pramana; Sinardja, I Ketut
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Anestesi pada pembedahan nonobstetri dalam kehamilan merupakan tantangan khusus bagi ahli anestesi. Sekitar 0,75%2% pembedahan nonobstetri dilakukan selama masa kehamilan. Setiap tahunnya di AS diperkirakan sekitar 75.000 wanita hamil menjalani anestesi dan pembedahan. Penatalaksanaan anestesi optimal memerlukan pemahaman mengenai perubahan fisiologi maternal, pertimbangan terhadap fetus akibat pembedahan dan anestesi, dan upaya mempertahankan perfusi uteroplasenta dan oksigenasi maternal-fetus. Tujuan yang ingin dicapai adalah anestesi yang aman kepada ibu dan memelihara kesejahteraan janin. Kami melaporkan kasus wanita berusia 29 tahun dengan G4P1A21 25?26 minggu janin tunggal hidup yang mengalami kelemahan motorik akut pada kedua tungkai bawah, gangguan sensibilitas semua kualitas setinggi Th6, serta inkontinensia urine dan alvi. Hasil pemeriksaan penunjang magnetic resonance imaging thorakolumbal menunjukkan suatu massa di daerah epidural setinggi C7Th1 sisi kanan dan hambatan aliran likuor serebrospinal. Pasien dilakukan anestesi umum dengan intubasi endotrakeal. Induksi menggunakan propofol dan fentanyl, diikuti dengan penekanan krikoid. Fasilitas intubasi menggunakan vecuronium. Pemeliharaan menggunakan isofluran, oksigen, compressed air, bolus fentanyl dan vecuronium intravena intermitten. Posisi operasi adalah posisi prone. Intraoperatif ditemukan tumor ekstradura setinggi level C7Th1, dilakukan laminektomi total dan stabilisasi dengan pemasangan pedicle screw. Pascabedah pasien menunjukkan perbaikan status neurologis dan kehamilan dapat dipertahankan sampai aterm.Anesthesia Management for Spinal Cord Tumor in PregnancyAnesthesia management for non-obstetric surgery in pregnancy was considered a specific challenge for anesthesiologist. About 0,752% of non-obstetric surgery is performed during pregnancy. Annually in the US, about 75.000 pregnant women are exposed to anesthesia and surgery. Optimal anesthetic management requires comprehensive understanding on maternal physiologic changes, fetal consideration due to effect of surgery and anesthesia, and maintaining uteroplacental perfusion and maternal-fetal oxygenation. The endpoint is to provide safe anesthesia for both the mother and fetal well being. We reported a case of a 29-year old pregnant woman G4P1021 single fetus with 2526 weeks of gestation, acute weakness of lower limbs, and sensibility impairment on all qualities at Th 6 level, as well as urine and alvi incontinence. Thoraco lumbal MRI examination showed epidural mass at C 7Th 1 level of the right side vertebrae, and cerebrospinal fluid flow obstruction. The patient underwent general anesthesia with endotracheal intubation. Induction with propofol and fentanyl, followed by cricoid pressure. Intubation was facilitated with vecuronium. Maintenance with isoflurane, oxygen, compressed air, intermittent IV bolus of fentanyl and vecuronium. Surgery was performed on prone position. Extradural tumor at C7Th1 vertebrae level was found intraoperatively and total laminectomy and stabilization with pedicle-screw were performed. Patient showed improvement in neurological status after the surgery, and the pregnancy was survived until aterm period.

Perbedaan Respon Hemodinamik terhadap Penambahan Clonidin 1 dan 2 mcg/kgbb pada Scalp Block untuk Operasi Kraniotomi Afif, Syarif; Arianto, Tri Ardana; Santosa, Sugeng Budi
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Latar Belakang dan Tujuan: Blok scalp levobupivakain efektif dalam menurunkan respon hemodinamik seperti tekanan darah, tekanan arteri rata-rata (mean arterial pressure/MAP) dan laju nadi terutama pada waktu pemasangan pin, insisi kulit, dan insisi durameter pasien kraniotomi. Adjuvan sering ditambahkan pada anestesi lokal untuk memperkuat dan memperpanjang efek analgesia pada blok saraf tepi. Klonidin memiliki aksi yang sinergis dengan agen lokal anestesi. Dosis yang umum adalah 2 mcg/kgbb. Tujuan penelitian ini untuk mengetahui efektifitas penambahan klonidin 1 mcg/kg dan 2 mcg/kg pada blok scalp sebagai analgetik kraniotomi.Subjek dan Metode: Penelitian pada 30 pasien memenuhi kriteria inklusi. Subyek dibagi tiga kelompok, kelompok I: blok scalp dengan levobupivacain 0,25%, kelompok II: blok scalp ditambah klonidin 1 mcg/kg, dan kelompok III: blok scalp ditambah klonidin 2 mcg/kg. Semua pasien mendapatkan perlakuan anestesi umum sesuai standar kemudian dilakukan penilaian tekanan darah, MAP, laju nadi pada sebelum intubasi, pemasangan pin, insisi kulit dan insisi duramater.Hasil: Ada perbedaan signifikan penambahan klonidin dibandingkan dengan kelompok kontrol terutama pada laju nadi dan diastolik kraniotomi. Klonidin 2 mcg/kgbb pada beberapa waktu menunjukkan perbedaan signifikan dibandingkan dosis klonidin 1 mcg/kgbb. Simpulan: Penambahan klonidin pada blok scalp levobupivakain efektif dalam menjaga respon hemodinamik terutama laju nadi dan tekanan darah diastolik.Differences in Hemodynamic Response to 1 and 2 mcg/kgbw Clonidine Addition to Scalp BlockAbstractBacground and Objective: The addition of a levobupivacaine scalp block is effective in reducing hemodynamic responses such as blood pressure, mean arterial pressure (MAP) and pulse rate, especially when pinning, skin incisions, and durameter incisions in craniotomy. Adjuvants are often added to local anesthetics to enhance and prolong the analgesic effect of peripheral nerve blocks. Clonidine has a synergistic action with local anesthetic agents. Clonidine increases sensory and motor blocks in both peripheral and neuraxial blocks. The common dose is 2 mcg/kgbw. The aim of this study was to determine the effectiveness of adding clonidine 2 mcg/kg and 1 mcg/kg on scalp block as craniotomy analgesic.Subjects and Methods: Study on 30 patients met the inclusion criteria. Subjects were divided into three groups, group I: scalp block with levobupivacain 0.25%, group II: scalp block plus clonidine 1 mcg/kg, group III: scalp block plus clonidine 2mcg/kg. All patients were treated with general anesthesia according to the standard then assessed their blood pressure, MAP, pulse rate before intubation, pinning, skin incision and duramater incision.Results: There was a significant difference in the addition of clonidine with the control group, especially in the pulse and diastolic rates. Clonidine 2 mcg/kg at several times showed a significant difference compared to 1 mcg/kgbb dose.Conclusion: The clonidine addition to scalp block of levobupivacaine was effective in maintening hemodynamic responses, especially pulse rate and diastolic blood pressure.

Terapi Hipotermia pada Stroke Hemoragik Aulyan Syah, Bau Indah; Fuadi, I; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Terapi antipiretik merupakan salah satu terapi yang dianjurkan untuk pasien stroke karena peningkatan suhu tubuh dianggap berhubungan dengan luaran neurologis yang buruk. Namun demikian, belum ada rekomendasi yang paling tepat untuk kontrol demam baik secara farmakologi maupun mekanik akibat kurangnya temuan klinik.Saat ini, hipotermi terapeutik dianggap satu-satunya metode neuroprotektif yang sukses dalam meningkatkan luaran pasien stroke iskemik. Istilah neuroprotektif disini mengacu pada memelihara atau melindungi cedera saraf yang reversibel agar tidak rusak atau mengalami kematian sel. Metode hipotermi dianggap berpengaruh terhadap sejumlah jalur patofisiologi stroke. Pada penelitian in vitro, hipotermi mencegah edema serebral dan kerusakan sawar darah otak. Selain itu, mencegah aktivasi mikroglia, produksi radikal bebas, dan pelepasan neurotransmitter eksitotoksik serta asam laktat dan piruvat. Selain itu, cerebral metabolic rate (CMR), apoptosis dan respon inflamasi lokal juga berkurang. Hipotermi otak secara lokal dilaporkan menurunkan ekspresi gen interleukin-1b dan pembentukan edema vasogenik pada model perdarahan intraserebrial binatang. Hipotermi terapeutik dianggap lebih efektif bila dimulai lebih awal setelah onset gejala. Durasi hipotermia yang lebih lama juga memiliki efek neuroprotektif persisten dalam jangka waktu lama. Namun demikian, terapi hipotermia memiliki beberapa komplikasi terhadap jantung, paru-paru, immunologi, hematologi, dan metabolik. Komplikasi yang paling sering dilaporkan adalah pneumonia, bradikardi, aritmia, dan trombositopenia. Evaluasi efektivitas hipotermia sulit dievaluasi pada pasien yang tersedasi karena pemeriksaan neurologis harian seringkali membingungkan.Hypothermia Therapy in Hemorrhagic StrokeAntipyretic is among one of the suggested therapies for stroke patients. The reason is because increase in body temperature is considered related to bad neurological outcomes. However, there is no best recommendation available for controlling the temperature, neither pharmacologically nor mechanically due to less clinical practices findings available. Currently, therapeutic hypothermia is considered as the one and only successful neuroprotective in enhancing the ischemic strokes patients outcomes. The term neuroprotective refers to protecting or conserving various types of reversible neurological injuries from damage or further cell impairment. In vitro studies showed hypothermia prevent cerebral edema and blood brain barrier damage, as well as successfully proven effective in preventing microglia activation, free radical production, and release of exotoxic neurotransmitters, lactic acid and piruvate. In addition, cerebral metabolite rate (CMR), apoptosis, and local inflammatory response are also decreased. Local brain hypothermia is reported could lowering the 1b-interleukin gen expression and establishment of vasogenic edema among animal models with intracerebral hemorrhage. Therapeutic hypothermia is considered highly effective when initiated early in subsequent to the symptom onset. Longer duration of cooling is related to a more persistent neuroprotective effect in long periode. Despite its effectiveness, therapeutic hypothermia could generate several complications affecting the heart, lung, immunology, hepatology and metabolic states. The most common complications are pneumonia, bradicardia, arrhythmia, and thrombocytopenia. Evaluation to the effectiveness of hypothermia is difficult to measure in sedated patients due to difficulty in defining the patients neurological states on day to day bases

Peran Eritropoietin pada Stroke Iskemik Akut Amalia, Lisda; Saputra, Gilang Nispu
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
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Stroke iskemik merupakan salah satu penyebab stroke tersering, disebabkan oleh oklusi pembuluh darah serebral dan penyebab kematian ketiga. Iskemik otak akan menghasilkan penghasilan mediator inflamasi yang dapat berpartisipasi dalam jejas iskemik di otak. Saat awitan stroke iskemik terjadi, area otak yang diperdarahi oleh pembuluh darah akan kekurangan oksigen dan nutrisi sehingga sel otak terutama neuron berada dalam risiko, neuron ini masih dapat berfungsi yang dikenal sebagai penumbra. Hipoksia jaringan dan iskemik serebral mengaktivasi HIF-1?, yang kemudian mengaktivasi transkripsi gen eritropoietin (EPO) dan Vascular Endothelial Growth Factor (VEGF). Eritropoietin (EPO) merupakan peptida yang juga memiliki efek nonhematopoiesis yaitu berperan mendorong neuroproteksi. Eritropoietin (EPO) dikeluarkan dalam hitungan menit dari proses iskemik dan mencapai puncak dalam 24 jam dari awitan stroke iskemik. Efek neuroproteksi dari EPO yaitu sebagai anti apoptosis, anti oksidan, anti inflamasi, anti eksitoksisitas, neurogenesis, angiogenesis dan neurotropik. Dengan kata lain bahwa EPO dapat mengurangi derajat keparahan akibat oklusi pembuluh darah otak.Role of Eritropoietin in Acute Ischemic StrokeAbstractIschemic stroke is one of the most common causes of stroke, caused by cerebral vascular occlusion and the third cause of death. . Ischemic brain will generate income of inflammatory mediators who can participate in ischemic lesions in the brain. When the recitation of an ischemic stroke occurs, areas of the brain that are obscurated by blood vessels will lack oxygen and nutrients so that brain cells, especially neurons, are at risk, these neurons can still function known as penumbra. Tissue hypoxia and cerebral ischemic activate HIF-1?, which then activates the transcription of the Eritropietin (EPO) and Vascular Endothelial Growth Factor (VEGF) genes. Eritropoietin (EPO) is a peptide that also has the effect of non-hematopoiesis which is responsible for encouraging neuroprotection. Eritropietin (EPO) is issued in minutes of an ischemic process and reaches its peak within 24 hours of the onset ischemic stroke. The neuroprotection effect of EPO is as anti-apoptosis, anti-oxidant, anti-inflammatory, anti-excitation, neurogenesis, angiogenesis and neurotropic. In other words, EPO can reduce the severity due to occlusion of brain blood vessels.

Efek perbedaan Volume Tidal Ventilasi Mekanik Selama Operasi terhadap Rasio PaO2/FiO2 Pascakraniotomi Elektif Aditianingsih, Dita; Sedono, Rudyanto; Baktiar, Yoshua
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
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Latar Belakang: Kraniotomi elektif memiliki insidens komplikasi paru pascaoperasi (25%) dan mortalitas (10%) yang tinggi; insiden ini lebih rendah pada pemakaian volume tidal rendah sebagai teknik proteksi paru. Penelitian ini meneliti efek volume tidal 6 mL/kg dan 10 mL/kg terhadap rasio PaO2/FiO2(sebagai parameter keparahan cedera paru) pascaoperasi pada kraniotomi elektif.Subjek dan Metode: Setelah mendapat izin Komite Etik FKUI/Rumah Sakit Cipto Mangukusumo dan konsen pasien, dilakukan uji klinis acak pada 52 pasien kraniotomi elektif yang dirandomisasi ke dalam 2 kelompok: ventilasi mekanik selama operasi dengan volume tidal 6 mL/kg (VT6) atau 10 mL/kg (VT10), lalu dilakukan analisis gas darah.Hasil: Rasio PaO2/FiO2 kelompok VT-6 dan VT10 secara berurutan: pada 1 jam pascainduksi 413,7 113,4 mmHg dan 401,5 106,3 mmHg (p0.05); pada akhir operasi, 466,6 94,6 mmHg dan 471,1 89,0 mmHg (p0.05), pada 24 jam pascainduksi, 418,8 108,8 mmHg dan 448,5 119,6 mmHg (p0.05); pada 48 jam pascainduksi, 414,9 88,1 mmHg dan 402,5 100,7 mmHg (p0.05 ). Tidak ada perbedaan signifikan insiden mortalitas dan komplikasi paru dan ekstraparu diantara dua kelompok.Simpulan: Tidak ada perbedaan signifikan antara volume tidal 6 ml/kg dan 10 ml/kg terhadap ratio PaO2/FiO2 pada pasien kraniotomi elektif.The Effect of Different Tidal Volume against Postoperative PaO2/FiO2 Ratio in Elective Craniotomy PatientsBackground: Elective craniotomy is associated with a high incidence of postoperative pulmonary complications/PPC (25%) and mortality (10%); in which these incidence went down with the administration of low tidal volume. This study investigated the effect of low tidal volume in intraoperative PaO2/FiO2 ratio in elective craniotomy patients.Subject and Methods: After approval from Ethics Committee Faculty of Medicine Universitas Indonesia, Ciptomangunkusumo Hospital and consent from patients,a randomized controlled trialwas done to 52 elective craniotomy patients. Subjects were ventilated with tidal volume 6 mL/kg (VT6) or 10 mL/kg (VT10) intraoperatively, then blood gas analyses wereperformed.Results: PaO2/FiO2 ratio of VT6 and VT10 respectively: at 1 hour postinduction, 413.7 113.4 mmHg and 401.5 106.3 mmHg (p0.05); at end of surgery, 466.6 94.6 mmHg and 471.1 89.0 mmHg (p0.05); at 24 hours postinduction, 418.8 108.8 and 448.5 119.6 mmHg (p0.05); at 48 hours postinduction, 414.9 88.1 mmHg and 402.5 100.7 mmHg (p0.05). There were no significant differences on mortality, lung and extralung complications observed between both groupsConclusions: There were no significant difference between tidal volume 6 ml/kg and 10 ml/kg against intraoperative PaO2/FiO2 ratio in elective craniotomy patients.

Kemoterapi pada Pasien Operasi Tumor Otak Metastasis: Apa Implikasi Anestesinya? Putri, Dini Handayani; Bisri, Dewi Yulianti; Rasman, Marsudi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
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Tumor otak metastasis adalah salah satu jenis keganasan intrakranial yang paling umum di temukan pada dewasa. Di Amerika Serikat sendiri tumor otak metastasis mencapai 150.000 170.000 kasus pertahun. Lebih dari 50% tumor otak metastasis terletak di supratentorial, dapat memberikan gejala neurologis, sangat bergantung akan jumlah lesi, ukuran lesi, serta ukuran dari edema vasogenik yang terjadi dan menekan jaringan otak sekitarnya. Lima sumber paling umum dari tumor otak metastasis adalah payudara, colorectal, ginjal, jantung dan melanoma. Dari keseluruhan pasien dengan tumor otak akibat metastasis 8 14% akan menjalani operasi pengangkatan tumor dengan beberapa pertimbangan seperti didapatkan tanda tanda kegawatdaruratan neurologis, ukuran massa yang besar, jenis tumor primer, grade tumor, lokasi tumor, resiko, komplikasi operasi dan Karnofsky Performance Score (KPS). Pasien tumor otak metastasis tentunya datang dengan dengan riwayat tumor ganas pada organ tubuh lainnya dan telah menjalani kemoterapi sebagai terapi. Pasien dengan riwayat kemoterapi memerlukan perhatian khusus karena selain membunuh sel kanker, kemoterapi dapat memberi efek toksik pada sistem organ, baik efek jangka pendek maupun efek jangka panjang, sehingga di perlukaan tatalaksana perioperatif yang seksama pada operasi tumor otak metastasis agar didapatkan hasil luaran yang baik.Chemotherapy In Patients with Metastatic Brain Tumor Surgery: What are the Implications of Anesthesia?Metastatic brain tumor is one of the most common types of intracranial malignancies found in adults. In the United States alone metastatic brain tumors attain. 150,000 - 170,000 cases per year. Metastatic brain tumor of more than 50% is located in the supratentorial, may provide neurological symptoms, highly dependent on the number of lesions, the size of the lesion, as well as the size of the vasogenic edema that occurs and suppress the surrounding brain tissue. The five most common sources of metastatic brain tumors are breast, colorectal, kidney heart and melanoma. Of all patients with brain tumors due to metastasis 8 to 14% will undergo tumor removal surgery with some considerations such as the emergence of signs of neurological emergency, large mass size, type of primary tumor, tumor grade, tumor location, risk complication of surgery, and Karnofsky performance score (KPS). Patients with metastatic brain tumors certainly come with a history of malignant tumors in other organs and have undergone chemotherapy as therapy. Patients with a history of chemotherapy require special attention because in addition to killing cancer cells, chemotherapy can have a toxic effect on the organ system, both short-term and long-term effects, so a careful perioperatif treatment in patients with brain tumor metastasis surgery is mandatory in order to obtain good results.

Manajemen Anestesi untuk Evakuasi Epidural Hemorrhage bersama dengan Operasi Fraktur Cruris Terbuka Subekti, Bambang Eko; Oetoro, Bambang J.; Rasman, Marsudi; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala merupakan masalah kesehatan utama, pemicu kecacatan dan kematian di seluruh dunia. Epidural Hemorrhage (EDH) adalah salah satu bentuk cedera kepala yang sering terjadi. Epidural Hemorrhage umumnya terjadi karena robeknya arteri dan menyebabkan perdarahan di ruangan antara duramater dan tulang tengkorak. Kejadian cedera kepala ini biasanya juga dikuti dengan cedera di bagian tubuh lain yang juga memerlukan tindakan operasi. Penatalaksanaan cedera kepala saat ini difokuskan pada stabilisasi pasien dan menghindari gangguan intrakranial ataupun sistemik sehingga dapat menghindari cedera sekunder yang lebih buruk. Seorang laki-laki, 20 tahun, dibawa ke rumah sakit dengan penurunan kesadaran, fraktur femur tertutup dan fraktur cruris terbuka karena kecelakan lalu lintas. Setelah resusitasi dan stabilisasi didapatkan jalan napas bebas, laju pernapasan 12 x/menit (reguler), tekanan darah 130/85 mmHg, laju nadi 78 x/menit (reguler). Pada pasien dilakukan tindakan kraniotomi evakuasi hematoma dan debridement pada luka yang terbuka dengan anestesi umum dan dengan memperhatikan prinsip neuroanestesi selama tindakan bedah berlangsung.Anesthetic Management for Evacuation of Epidural Hemorrhagealong with Surgery Open Fracture CrurisHead trauma is a major health problem and considered as the leading cause of disability and death worldwide. Epidural Hemorrhage (EDH) is commonly seen in head trauma. Epidural Hemorrhage usually occurs due to ripped artery that coursing the skull causing blood collection between the skull and dura. The incidence of head trauma is usually followed by injuries in other body parts that require surgery.Head trauma management is currently focusing on patients stability and prevention the intracranial and haemodynamic instability to prevent the secondary brain injury. A 20 years old male patient, admitted to the hospital with decreased level of consciousness, closed fracture femur and open fracture cruris after traffic accidents. On examination, no airway obstruction found, respiratory rate was 12 times/min (regular), blood pressure 130/85 mmHg, heart rate 78 bpm (regular). Patient was managed with emergency hematoma evacuation and debridement of wounds under general anesthesia and with continues and comprehensive care using neuroanesthesia principles.

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Contact Name
Agni Susanti

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jurnalneuroanestesi@gmail.com

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+6287722631615

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

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INDONESIA