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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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Peran Neuro Critical Care Pada Tata Laksana Pasien Cedera Aksonal Difus Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Cedera aksonal difus (Diffuse Axonal Injury / DAI) adalah keadaan penderita dengan kehilangan kesadaran, lebih dari 6 jam pada cedera otak traumatik berat dan tanpa lesi masa intrakranial. Berdasar lama kondisi koma pada pasien, DAI dibagi menjadi 3 kategori, kelas I (ringan), kelas II (sedang), kelas III (berat). Bila tidak ditangani dengan cepat dan tepat, kemungkinan pasien akan mengalami cacat permanen dan tetap dalam kondisi vegetative. Peran Neuro Anestesi dan Critical Care adalah untuk menangani penderita, dimulai dari tempat kejadian trauma hingga perawatan neurointensif. Seorang wanita, umur 18 tahun, berat badan 50 kg, tinggi 165 cm. Mengalami kecelakaan sepeda motor, kemudian penderita pingsan mulai dari tempat kejadian sampai dibawa ke rumah sakit. Dilakukan monitoring tekanan intrakranial (ICP) dan perawatan cedera otak traumatik berat pada umumnya. Pada hari ke 4 setelah trauma, penderita mulai sadar, dapat diperintah dan dengan nilai Glasgow Outcomes Scale (GOS): 3 (cacat parah). DAI terjadi karena cedera otak berat setelah trauma sehingga menyebabkan penurunan kesadaran tanpa adanya lesi masa intrakranial maupun iskemik. Bermacam-macam teori dikemukakan mengenai terjadinya DAI. Penatalaksanaan DAI tidak ada yang khusus, dilaksanakan penanganan seperti pada cedera otak traumatik umumnya, hanya diperlukan pencegahan cedera sekunder dan mempertahankan tekanan intrakranial (ICP) dalam kondisi normal. Prognosa tergantung dari jenis DAI yang terjadi.The Role Of Neurocritical Care On Diffuse Axonal Injury Management Diffuse Axonal Injury (DAI) is a state of long-time unconsciousness, more than 6 hours in severe traumatic brain injury and without mass lesions of intracranial. According to how long the patient still in coma condition, DAI is divided into 3 categories, grade I (mild), grade II (moderate), grade III (severe). If this condition not addressed quickly and accurately, the patient may will get a permanent disability and still in a vegetative state condition. The importance of Neuro-anesthesiologist and Critical Care is to take care of the patient, from the trauma site until in the neurointensive care. A woman, 18 years old, weight 50 kg, height 165 cm. She had a motorcycle accident and unconscious from the trauma site until she got into the hospital. Intra Cranial Pressure (ICP) Monitoring and a treatment of traumatic brain injury in general was performes. On the 4th day after trauma, the patient began to understand the command that was given and the GOS (Glasgow Outcomes Scale) is 3 (severe disability). DAI occurs due to severe brain injury after trauma resulting in impairment of consciousness with the absence of intracranial mass lesions and also ischemia. The various theories bring to the surface regarding the occurrence of DAI. The management in DAI is nothing specials, it contains the treatment in traumatic brain injury in general, the prevention of secondary injury and maintain ICP in normal condition is essentials. The prognosis is depends on the type DAI that was occurs.

Pengelolaan Perioperatif Anestesi pada Pasien dengan Pembedahan Hipofisis Surgery Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Pengelolaan perioperatif pada pasien yang menjalani pembedahan kelenjar hipofisis bervariasi sesuai dengan ukuran lesi hipofisis, jenis lesi, metode pembedahan yang digunakan serta fungsi endokrin yang ideal pra-pembedahan. Permasalahan tertentu pada kebanyakan pasien berhubungan dengan kondisi hipersekresi hormon primer serta komplikasi yang menyertainya. Hal ini disebabkan karena tidak adanya metode yang terbaik untuk semua pasien yang menjalani proses pembedahan. Kelenjar hipofisis terletak didasar tulang tengkorak, didalam sella turcica, tepat dibelakang chiasma optica. Kelenjar ini dibagi menjadi dua bagian, yaitu; pars anterior (adenohipofisis) dengan area 75% yang merupakan bagian paling besar, dan pars posterior (neurohipofisis) yang menyatu dengan hipotalamus. Kelenjar ini mensekresi hormon yang juga dikontrol oleh hipotalamus secara hormonal impuls nervus. Tumor hipofisis pada umumnya berasal dari daerah anterior hipofisis, bersifat jinak dan secara gambaran histologis menyerupai kelenjar hipofisis yang normal. Diperlukan adanya serangkaian pemeriksaan awal sebelum dilakukan tindakan bedah pada pasien. Pengelolaan anestesi pada saat proses pembedahan, disesuaikan dengan teknik pembedahan yang dilakukan. Hal lain yang juga tidak kalah pentingnya adalah monitoring kondisi pascabedah pada neurointensive care yang terkait dengan komplikasi dan metode penggantian hormon sementara setelah tindakan bedah dilakukan. Pemahaman mengenai penilaian pra operasi, tata laksana intra operatif, komplikasi yang mungkin terjadi, teknik pembedahan dan cara-cara pencegahan komplikasi, merupakan dasar keberhasilan perawatan pasien perioperatif sehingga mencegah morbiditas dan mortalitas.Perioperative Management Anesthesia on Patients Undergoing PituitaryPerioperative management on patients undergoing pituitary surgery is varies according to the size of pituitary lesion, type of lesion, surgical method used and the ideal preoperative function of endocrine. Specific problems in most patients relate to primary hormonal hypersecretion conditions and its complications. It cause by the absence of best methods for all patients undergoing this kind of surgery. Pituitary glands lie on the floor of the skulls bone, in sella turcica, right behind the chiasma optica. This glands was divided into two parts, pars anterior (adenohypophyse), its about 75% which is the biggest part of it, and the pars posterior (neurohypophyse) that fused with hypothalamus. This gland secretes hormone that controlled impuls nervus by the hypothalamus. In general, pituitary tumor was came from pars anterior, benign adenoma and histoligically same with a normal glands. A series of initial evaluation is required before the surgery take to the patients. Anesthesia management in the surgery is adapted to its technique. The other things that is equally important is post operative monitoring in neurointensive care, according to complications and transient hormone replacement method after the surgery. The understanding of preoperative assessment, intraoperative management, potential complication, surgical methods and several ways to prevent complications are the fundamental for successful perioperative patients care to prevent morbidity and mortality.

Total Intra Venous Anesthesia (TIVA) Target Controlled Infusion (TCI) Propofol Remifentanil untuk Seksio Sesarea Emergensi pada Pasien Meningioma dengan Peningkatan Tekanan Intrakranial Aryasa, Tjahya; Fajar Apsari, Ratih Kumala; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 9, No 1 (2020)
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Meningioma sangat jarang ditemukan pada kehamilan, tapi kehamilan dapat memicu pertumbuhan meningioma. Ibu hamil yang menjalani seksio sesarea dengan penyulit tumor otak merupakan indikasi anestesi umum dengan kombinasi Target Controlled Infusion (TCI) propofol dan remifentanil. Propofol pada seksio sesarea dapat mengatasi respons simpatis akibat laringoskopi. Remifentanil berhubungan dengan hasil luaran lebih baik pada neonatus dari opioid lainnya. Perempuan 34 tahun, hamil 37 minggu datang dengan keluhan utama nyeri perut hilang timbul disertai kebutaan dan tanda peningkatan tekanan intrakranial tanpa penurunan kesadaran. Tidak dilakukan CT-Scan kepala karena direncanakan seksio sesarea emergensi. Dilakukan seksio sesarea dengan teknik anestesi umum menggunakan TCI propofol mode Marsh dengan target efek 34 mcg/ml dan TCI remifentanil dengan target 23 ng/ml, dan rocuronium dengan dosis 0,7 mg/kgBB. Pada menit kesepuluh, lahir bayi laki-laki, dengan berat badan 2000 gram dan skor APGAR 78. Selama operasi hemodinamik stabil dan tidak ada komplikasi. pascabedah dilakukaan pemeriksaan CT-scan dan ditemukan meningioma yang besar. Teknik ini memberikan hasil luaran pada neonatal dan ibu yang baik.Total Intra Venous Anethesia (TIVA) Target Controlled Infusion (TCI) with Propofol Remifentanil for Emergency Caesarean Section in Meningioma Patient with Increase Intracranial PressureAbstractMeningiomas are very rare in pregnancy, but pregnancy triggers the growth of meningiomas. Pregnant women who undergo cesarean section complicated with brain tumor are an indication of general anesthesia with Target Controlled Infusion (TCI) propofol and remifentanil. Propofol can blunt sympathetic response due to laryngoscopy. Remifentanil has a better outcomes in neonates than other opioids. A 34-year-old woman, 37-weeks pregnant presented with uterine contractions accompanied with blindness and signs of increased intracranial pressure without decreased consciousness. Head CT scan was not performed because an emergency cesarean section was planned. Caesarean section was performed with general anesthesia using Target Controlled Infusion (TCI) Marsh mode propofol with a target effect of 3-4 mcg/ml and remifentanil TCI with a target of 2-3 ng/ml, and rocuronium 0.7 mg/kg. At the tenth minute, a male baby was born, weighing 2000 grams and an APGAR score of 7-8. During surgery, the hemodynamic was stable without complications. Postoperatively, a CT scan was performed and a large meningioma was found. This technique provided good neonatal and maternal outcome outcomes.

Penatalaksanaan Anestesi Subarachnoid Hemoragik pada Ibu Hamil Mangastuti, Rebecca Sidhapramudita; Bisri, Dewi Yulianti; Oetoro, Bambang J.; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
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Subarachnoid hemorrhage (SAH) non traumatic pada wanita hamil, umumnya disebabkan oleh ruptur aneurisma atau arteriovenous malformation (AVM). Hipertensi pada pre eklampsi berat (PEB) dan eklampsi merupakan penyebab tersering. Gejala klinis SAH umumnya adalah nyeri kepala hebat, pandangan kabur, photofobia, mual, muntah, hingga penurunan kesadaran. Diagnosis ditegakkan berdasarkan anamnesa, pemeriksaan fisik dan pemeriksaan penunjang seperti computed tomography (CT-scan)/magnetic resonance imaging (MRI), computed tomographic angiography (CTA), magnetic resonance angiography (MRA), catheter angiography. Wanita hamil dengan aneurisma serebral menunjukkan perbaikan survival untuk ibu dan fetus bila clipping dilakukan setelah SAH dibandingkan dengan pengelolaan tanpa pembedahan. Reseksi AVM yang tidak pecah dapat ditunda sampai setelah melahirkan tanpa menunjukkan adanya peningkatan mortalitas ibu. Pertimbangan anestesi pada wanita hamil dengan SAH adalah keselamatan ibu dan fetus. Penurunan dari tekanan rerata ibu atau peningkatan resistensi vascular uterus akan menurunkan aliran darah uteroplasental sehingga menurunkan aliran darah umbilical yang akan membahayakan fetus. Pemberian cairan, manitol, tehnik hipotermi dan obat-obatan harus dipertimbangkan agar tidak membahayakan fetus. Pasca tindakan clipping aneurisma dilakukan triple H terapi yaitu hipertensi, hipervolemi dan hemodilusi. Prognosis ibu hamil dengan SAH sesuai dengan skala Hunt dan Hess. Makin rendah skala, makin rendah pula angka morbiditas dan mortalitas.Management Anesthesia for Pregnant Women with Subrachnoid HemorrhageNon traumatic subarachnoid hemorrhage (SAH) in pregnant women, generally caused by a ruptured aneurysm or arteriovenous malformation (AVM). Severe hypertension in pre eclampsia (PEB) and eclampsia are common causes. Clinical symptoms of SAH are severe headache, blurred vision, photofobia, nausea, vomiting, loss of consciousness. Diagnois is based on anamnesis, physical examination and computed tomography (CT scan) / magnetic resonance imaging (MRI), computed tomographic angiography (CTA), magnetic resonance angiography (MRA), catheter angiography. Pregnant women with cerebral aneurysms showed improved survival for both mother and fetus when clipping is done after SAH, compared with nonsurgical management. Unrupture AVM resection can be delayed until delivery, and not increased maternal mortality. Consideration of anesthesia in pregnant women with SAH is the safety of the mother and fetus. A decresase of pressure or increase in mean maternal vascullar resistance will decrease uteroplacental blood flow resulting in lower umbilical blood flow which would endanger the fetus. Fluid, mannitol, hypothermia techniques and preoperative, intraoperative and postoperative medicine should be considered, in order not to endanger the mother and fetus. Post aneurysma clipping, perfomed triple H therapy, hypertension, hipervolemik and hemodilution. The prognosis according to Hunt Hess scale, ie the lower the scale, the lower the rate of morbidity and mortality

Hipotermia untuk Proteksi Otak Bisri, Dewi Yulianti; Oetoro, Bambang J.; Harahap, M. Sofyan; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
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Proteksi otak adalah serangkaian tindakan yang dilakukan untuk mencegah atau mengurangi kerusakan sel-sel otak yang diakibatkan oleh keadaan iskemi. Iskemia adalah gangguan hemodinamik yang akan menyebabkan penurunan aliran darah otak sampai suatu tingkat yang akan menyebabkan kerusakan otak yang ireversibel. Iskemi serebral dan atau hipoksia dapat terjadi sebagai konsekuensi dari syok, stenosis atau oklusi pembuluh darah, vasospasme, neurotrauma, dan henti jantung. Hipotermia dibagi menjadi hipotermia ringan (33-36OC), hipotermia sedang (28-32OC), hipotermia dalam (11-20OC), profound (6-10OC), dan ultraprofound (5OC).Teknik hipotermia di bagi kedalam 3 fase yaitu: fase induksi, fase rumatan dan fase rewarming. Teknik hipotermia yang dianjurkan adalah hipotermia ringan hingga sedang dan penggunaannya segera setelah cedera otak traumatika dan tidak lebih dari 72 jam. Hipotermia dapat mempengaruhi sistem kardiovaskuler, sistem respirasi, infeksi dan fungsi saluran cerna, sistem ginjal, asam basa dan hematologi. Efek hipotermia sebagai proteksi adalah efek terhadap metabolism dan aliran darah otak, excitotoxicitas, oxidative stress dan apoptosis, inflamasi, blood-brain barrier (BBB), permeabilitas pembuluh darah dan pembentukan edema, dan terhadap mekanisme ketahanan hidup sel. Mekanisme proteksi otak dengan hipotermi belum sepenuhnya dimengerti dengan jelas, hanya sebagian saja diketahui bagaimana mekanismenya. Rewarming adalah proses pemulihan temperatur ini ke temperatur inti normal. Rewarming harus dilakukan sangat pelahan untuk mengurangi kejadian komplikasi seperti hipertemia, hiperkalemia dan kerusakan sel.Hypothermia for Brain ProtectionCerebral protection is the preemptive use of theurapeutic intervention to avoid or decrease neurologic damage cause by ischemia. Ischemia is defined as perfussion insufficient to the level will be cause irreversible brain damage. Cerebral ischemia and or hypoxia as consequency of shock, stenosis or vascular occlusion, vasospasm, neurotrauma, and cardiac arrest. Hypothermia were divided into mild hypothermia (33-36OC), hypothermia was (28-32oC), hypothermia in the (11-20oC), profound (6-10C), and ultraprofound (5oC). Hypothermia technique is classified into 3 phases namely: an induction phase, maintenance phase and the phase of rewarming. The recommended technique of hypothermia is mild to moderate hypothermia and its use soon after brain injury traumatika and not more than 72 hours. Hypothermia can affect the cardiovascular system, respiratory system, gastrointestinal tract infections and function, renal system, acid-base and hematologic. Effect of hypothermia as brain protective are effect on cerebral blood flow and metabolism, on excitotoxicity, oxidative stress and apoptosis, inflammation, blood-brain barrier (BBB), permeability of blood vessels and form of edema, and the mechanisms of cell survival. Mechanism of brain hypothermia protection as a whole is not clearly known mechanism, only in part be obvious how mthe mechanism. Rewarming is the core body temperature returns to normal core body temperature. Rewarming should be done very slowly to reduce the incidence of complication as hyperthermia, hyperkalemia and cell damage.

Manajemen Anestesi untuk Awake Craniotomy pada Space Occupying Lesion Lobus Frontalis Kiri Ferdyansyah, Ferry; Harahap, M. Sofyan
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
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Tumor intrakranial adalah suatu lesi ekspansif yang membentuk massa dalam ruang tengkorak. Kami melaporkan manajemen anestesi pada pasien dengan tumor intrakranial yang menjalani prosedur awake craniotomy. Seorang laki-laki berumur 39 tahun, berat badan 60 kg dengan riwayat epilepsi ditemukan space occupying lession pada lobus frontalis kiri setelah dilakukan CT-scan kepala. Prosedur awake craniotomy untuk pengangkatan tumor dilakukan karena lokasi tumor berada di dekat area Broca. Awake craniotomy dilakukan dengan kombinasi anestesi intravena (i.v) dexmedetomidin dan blok scalp. Premedikasi midazolam 2 mg i.v dan oksigenasi 3 liter/menit nasal diberikan dari awal proses operasi. Pasien diberikan dexmedetomidine loading dose 1 mcg/kgBB dalam 15 menit dan fentanyl 1 mcg/kgBB i.v sebelum dilakukan blok scalp dengan injeksi bupivacain isobarik 0,5% dicampur pehacain 1:1, total 40 ml untuk kedua sisi kepala. Infiltrasi larutan bupivacain-pehacain tambahan diberikan 2,5 ml pada setiap titik pin holder fiksasi kepala dipasang. Pemeliharaan anestesi dijaga dengan infus kontinyu dexmedetomidin 0,5-0,7 mcg/KgBB/jam i.v selama pasien terbangun dan propofol 0,05 0,1 mg/kgBB/menit i.v ditambahkan apabila pasien ditidurkan. Mannitol 1 g/kgBB i.v diberikan 15 menit sebelum duramater dibuka. Proses kraniotomi berjalan 4 jam. Selama operasi berlangsung pasien tidak mengalami perubahan hemodinamik yang signifikan, tekanan darah rata-rata 9569 mmHg, laju nadi 5663 x/mnt, SpO2 100% dengan VAS 0-1. Pasca operasi, pasien stabil dan pindah ke ruangan setelah diobservasi selama 1 jam di ruang pemulihan.Anesthesia Management for Awake Craniotomy on Left Frontal Lobe Solid Occupiying LesionIntracranial tumors are an expansive lesion that forms masses in the skull space. We report anesthesia management in patients with intracranial tumors who undergo awake craniotomy procedures. A 39-year-old male weighing 60 kg with a history of epilepsy found space occupying lession in the left frontal lobe after a head CT scan. The awake craniotomy procedure for removal of the tumor is done because the location of the tumor is near the Broca area. Awake craniotomy is performed with a combination of dexmedetomidine intravenous (i.v) and scalp block. Premedication with 2 mg midazolam i.v and oxygenation of 3 liters / minute nasal was given from the beginning of the surgery. The patient was given dexmedetomidine loading dose of 1 mcg/kg in 15 minutes and fentanyl 1 mcg/kg i.v before scalp block was done with 0.5% isobaric bupivacain injection mixed with 1: 1 Pehacain, a total of 40 ml for both sides of the head. Additional infiltration of bupivacain-pehacain solution was given 2.5 ml at each point the head fixation pin holder was installed. Maintenance of anesthesia is maintained with a continuous infusion of dexmedetomidine 0.5-0.7 mcg/Kg/h i.v as long as the patient is awake and propofol 0.05 - 0.1 mg/kg/minute i.v is added when the patient is put to sleep. Mannitol 1 g/kg i.v is given, 15 minutes before the duramater is opened. The craniotomy process runs 4 hours. During surgery, the patient does not experience significant hemodynamic changes, Mean Blood Pressure is 95-69 mmHg, heart rate 56-63 x/min, SpO2 100% with VAS 0-1. After surgery, the patient was stable and moved to the ward after being observed for 1 hour in the recovery room.

Dexmedetomidine sebagai Terapi Ajuvan untuk Operasi Tumor Fossa Posterior pada Bayi Umar, Nazaruddin; Silalahi, David
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Dexmedetomidine, agonis reseptor ?2 adrenergik-memberikan efek "sedasi kooperatif," ansiolitik, dan analgesia tanpa depresi pernafasan, efek simpatolitik dan antinosisepsi memungkinkan untuk stabilitas hemodinamik perioperatif. Kasus ini akan membahas neurofarmakologi dan neurofisiologi dari ?2-adrenergik agonis dan penerapan dexmedetomidine sebagai ajuvan. Bayi 1 tahun,10 kg, didiagnosa hidrosefalus obstruktif oleh adanya tumor di regio fossa posterior (yang telah menjalani 3 kali revisi VP-shunt), GCS10: E4V2M4, tekanan darah 90/40mmHg, laju nadi 150 x/menit, laju nafas 30 x/menit, suhu 36,8C, akan menjalani kraniektomi untuk pengangkatan tumor di regio fossa posterior pada posisi prone. Monitor non-invasif (tekanan darah, denyut jantung, SpO2, EKG, Kapnograph dan kateter urin). Premedikasi dengan midazolam 0,5 mg intravena. Induksi anestesi dengan ajuvan dexmedetomidine. Pemeliharaan anestesi dengan oksigen/udara, sevoflurane 0,6-1,0%, infus kontinyu dexmedetomidine dan pemberian selimut penghangat 370C. Pemantauan ketat dilakukan di ICU anak (PICU) dengan ventilasi mekanik dan diekstubasi pada esok pagi. Setelah hari ke-10 rawatan di PICU, pasien dipindahkan ke ruangan tanpa komplikasi neurologis perioperatif (GCS 12: E4V3M5). Manajemen, evaluasi serta pencegahan yang tepat terhadap kemungkinan komplikasi yang terjadi dapat meningkatkan luaran pasien.Dexmedetomidine as Ajuvant Therapy for Infant Undergoing Posterior Fossa Surgery Dexmedetomidine, an ?2-adrenergic receptor agonist offers a unique cooperative sedation, anxiolysis, analgesia without respiratory depression, sympatholytic and antinociceptive properties allow for hemodynamic stability at critical moments both for neurosurgical stimulation and emergence phase of anesthesia. One year infant, 10 kgs, admitted with loss of consciousness and head enlargement since 2 months of age, diagnosed obstructive hydrocephalus due to posterior fossa tumor and had underwent three VP-shunt revision surgeries. Preoperative with GCS8 E4V1M3, blood pressure 90/40mmHg, heart rate 150 beats/minute, respiratory rate 30/minute, temperature 36.8C, underwent craniectomy tumor removal for posterior fossa tumor in prone position. Premedication with midazolam 0.5 mg intravenous. Induction of anesthesia with ajuvant dexmedetomidine. Maintenance of anesthesia used oxygen/air with sevoflurane 0,6-1,0%, continuous infusion of dexmedetomidine, insertion of subclavian central vein cannulation and temperature preservation with warm blanket set to 370C. Post operation, patient was mechanically ventilated and monitored in Pediatric Intensive Care Unit (PICU) and extubated on the next morning. During in PICU, hemodynamic was stable and no worsening complication of neurologic deficit (GCS11 E4V3M5). After 10 days, patient moved to ward. The proper management, evaluation and prevention the possibility of these complications may improve patient outcome

Penatalaksanaan Perioperatif Cedera Kepala Traumatik dengan Jalan Nafas Sulit Christanto, Sandhi; Saleh, Siti Chasnak; Oetoro, Bambang J.; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala traumatik merupakan masalah kesehatan utama, pemicu kecacatan dan kematian di seluruh dunia. Walaupun terdapat cara diagnosis dan penatalaksanaan yang semakin mutakhir, prognosis tetap jauh dari harapan. Disamping derajat keparahan cedera primer merupakan faktor utama yang menentukan luaran, cedera sekunder yang disebabkan oleh hipotensi, hipoksemia, hiperkarbia, hiperglikemia, hipoglikemia dan lain lain, yang timbul seiring waktu setelah cedera awal, menyebabkan kerusakan lebih lanjut dari jaringan otak, memperberat luaran pada cedera kepala traumatik. Penatalaksanaan cedera kepala saat ini difokuskan pada pencegahan dan pengelolaan cedera sekunder karena cedera sekunder dapat dihindari dan diterapi. Seorang laki-laki, 46 tahun berat badan 100 kg, tinggi badan 175 cm ditemukan di pinggir jalan dengan dugaan akibat kecelakaan lalu lintas, setelah resusitasi dan stabilisasi didapatkan jalan napas bebas, laju napas 1618 x/menit, tekanan darah 160/90 mmHg, laju nadi 75 x/menit, skor GCS E2M5V2, pemeriksaan pupil kiri reaktif 3 mm, kanan sulit dievaluasi karena terdapat hematoma, terdapat lateralisasi dengan bagian tubuh kanan terlihat lebih aktif. Hasil CT Scan menunjukkan perdarahan subdural frontotemporoparietal kanan, perdarahan intraserebral dengan volume 21,8 cc, perdarahan subarachnoid frontotemporal kanan, pergeseran garis tengah sebesar 1,13 cm ke kiri, fraktur temporal kanan serta edema serebri. Keputusan tindakan kraniotomi evakuasi perdarahan segera dilakukan demi keselamatan pasien. Penatalaksanaan cedera kepala pada periode perioperatif yang meliputi evaluasi cepat, resusitasi berkesinambungan (serebral maupun sistemik), intervensi pembedahan dini, penatalaksanaan terapi intensif, diharapkan dapat memberikan jalan keluar potensial yang mungkin dapat memperbaiki luaran dari pasien dengan cedera kepala.Perioperative Management of Traumatic Brain Injury with Difficult AirwayTraumatic brain injury is major public health problem and leading cause of death and disability worldwide. Despite the modern diagnosis and treatment pathways, the prognosis remains poor. While severity of primary injury is the major factor to determine the outcomes, the secondary injury caused by hypotension, hypoxemia hypercarbia, hyperglicemia, hypoglicemia and et cetera, thet develop overtime after the onset of injury may cause further damage to brain tissues and worsen the outcome. Traumatic brain injury management currently focuses on prevention and secondary injury, treatment, since secondary injury is largely preventable and treatable. A 46 years old male patient, weighted 100 kgs, height 175 cm was found on the street as the suspect of traffic accident. On examination no obstruction in the airway, respiratory rate was16?18 x/minute, blood pressure was 160/90 mmHg, heart rate was 75x/minute, GCS scale was E2M5V2. The cranial hemorrhage was found in the right frontotemporal, intracerebral (approximately 21,8 cc), cerebral edema, and the midline shift more than 1 cm were seen on brain CT-Scan examination. The decision of emergency craniotomy evacuation was immediately made to save the live of the patient. The management in perioperative period involving rapid evaluation, continued with resuscitation (cerebral and systemic), early surgical intervention intensive care management, may be a potential window that will improve the outcome of traumatic brain injury patients

Peran Ferritin pada Stroke Iskemik Akut Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Stroke merupakan defisit neurologis yang terjadi karena jejas fokal akut pada sistem saraf pusat yang semata-mata terjadi karena gangguan vaskuler, termasuk infark serebri maupun perdarahan. Ferritin adalah protein intraselular dan ekstraselular penyimpan zat besi yang penting bagi homeostasis besi dalam tubuh. Ferritin diekspresikan di mikroglia dan makrofag, namun ada juga di dalam neuron. Pada saat terjadi kerusakan sel akibat stroke iskemik, ferritin akan keluar dari sel dan masuk ke dalam serum. Keadaan hipoksia-iskemia pada stroke menginduksi ekspresi dari ferritin pada oligodendrosit dan mikroglia. Saat terjadi stres oksidatif, pembentukan ferritin akan meningkat. Fungsi ferritin pada saat stres oksidatif terjadi, masih kontroversial. Ferritin dalam kondisi tersebut dapat berperan sebagai pembersih (scavenger) dan sebagai donor untuk ion besi bebas. Pasien stroke iskemik dengan lesi yang lebih besar dan defisit neurologis yang lebih berat menunjukkan peningkatan kadar serum ferritin yang lebih tinggi dan kecenderungan terjadinya komplikasi trasformasi perdarahan akan semakin tinggi pula.Role Of Ferritin in Acute Ischemic Stroke: A Literature ReviewAbstractStroke is a neurological deficit that occurs due to acute focal injury to the central nervous system that occurs solely due to vascular disorders, including cerebral infarction or bleeding. Ferritin is an intracellular and extracellular iron storage protein which is essential for iron homeostasis in the body. Ferritin is expressed in microglia and macrophages, and also in neurons. If there is cell damage due to ischemic stroke, ferritin will leave the cells and enter the serum. The hypoxia-ischemic state in stroke induces the expression of ferritin in oligodendrocytes and microglia. When there is oxidative stress, ferritin formation will increase. The function of ferritin in times of oxidative stress is still controversial. Ferritin in this condition can act as a scavenger and as a donor for free iron ions. Ischemic stroke patients with larger lesions and more severe neurological deficits showed higher serum ferritin levels and a higher likelihood of complications of bleeding transformation.

Penanganan Anestesi pada Ventriculo Peritoneal Shunt Cito e.c Hidrocephalus dengan Perdarahan Intraventricular Novitasari, Dian; Fuadi, Iwan; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Perdarahan intraventrikular akibat perluasan perdarahan subarahnoid ke ruang intraventrikel atau akibat perdarahan intraserebral menyebabkan hidrosefalus merupakan prediktor independent prognosis yang buruk pada stroke hemoragik. Kondisi hidrosefalus dengan perdarahan intraventrikular membutuhkan Ventriculo Peritoneal (VP) Shunt segera untuk menghindari defisit neurologis permanen bahkan kematian. Pasien seorang laki-laki dewasa (56 tahun) dengan bb 75 kg, dengan hipertensi kronis dan penurunan kesadaran disertai hipertensi intrakranial dengan CT Scan menunjukkan adanya hidrosefalus disertai perdarahan intraventrikular luas. Dilakukan anestesi dengan kombinasi anestesia intravena menggunakan propofol, dexmedetomidine - sevofluran 1 MAC dapat menjadi pilihan dalam operasi bedah saraf. Tindakan VP Shunt segera pada pasien ini merupakan tindakan yang bersifat life saving dengan managemen anestesi yang baik memberikan outcome yang baik.Anesthesia Management for Emergency Ventriculo Peritoneal Shunt ec Hydrocephalus with Intraventricular HemorrhageIntraventricular hemorrhage due to the expansion of subarachnoid hemorrhage due to space intraventricular or intracerebral hemorrhage cause hydrocephalus is an independent predictor of poor prognosis in hemorrhagic stroke. Hydrocephalus condition with intraventricular hemorrhage requiring ventriculo peritoneal (VP) shunt immediately to avoid permanent neurological deficits and even death. In this case report will discuss the management of anaesthesia in emergency VP Shunt for a patient with chronic hypertension, history of loss of consciousness accompanied by intracranial hypertension and CT scan result showed the existence of intra-ventricular hemorrhage with hydrocephalus wide. The combination of intravenous anesthesia using propofol, dexmedetomidine - 1 MAC sevoflurane may be an option in the operation of neurosurgery. VP Shunt immediate action in these patients is an act that is life saving with good anesthetic management provides a good outcome.

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Home Page

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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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Abstract

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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

Location
,

INDONESIA