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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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Manajemen Perioperatif Trepanasi Dekompresi Subdural Hemorrhage (SDH) dengan Hemofilia A Praniarda, Andika Satria; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Haemofilia A is congenital blood disease with female carrier, usualy found in male patient and happened for life. When one coagulation factor is lost or disfunction, coagulation mechanism will be disturbed and the bleeding difficult to stop. In this day, brain injury caused by trauma is the first cause of death in patient with haemophilia. Surgery in intracranial bleeding must be done as much as possible to get better prognosis. Blood evacuation must undergo quickly but very risky for rebleeding. Factor VIII must be given as soon as possible for treatment in severe haemophiliaA patient with acute bleeding. Maintenance anesthesia also include decrease risk of hypertension and tachicardia for minimalize the ongoing bleeding.Male 17thyears old diagnose with brain injury 2x4 caused by subdural hemorrhage (SDH) left frontotemporoparietal region and cerebral edema followed by subfalcine herniation to the right and haemophilia A planned for decompression evacuation of SDH. Patient got factor VIII 4000unit before operation. Intraoperative bledding are 1100cc and get 1940cc of blood product for stabilize the haemodynamic. Post operative was observe in Intensive Care Unit and went for extubation after 8thday after in good condition.Hemofilia adalah kelainan darah bawaan yang serius dengan wanita sebagai pembawa, terutama didapatkan pada pria dan berlangsung sepanjang hidup dimana hemofilia A merupakan tipe hemofilia tersering. Ketika salah satu faktor yang diperlukan untuk pembekuan darah hilang atau memiliki fungsi yang tidak memadai, mekanisme koagulasi yang terganggu menyebabkan perdarahan yang tidak dapat dihentikan. Saat ini, penyebab kematian paling umum di antara pasien hemofilia adalah perdarahan otak karena trauma kepala. Kasus perdarahan intrakranial sebisa mungkin dilakukan tindakan operasi segera untuk mendapatkan prognosis yang lebih baik. Tindakan evakuasi perdarahan harus dikerjakan dalam waktu singkat namun memiliki resiko tinggi terjadinya perdarahan ulang. Pemberian penggantian faktor VIII rekombinan untuk pengobatan perdarahan akut pada pasien hemofilia A berat harus dilakukan segera. Rumatan anestesi juga harus mencakup penurunan resiko hipertensi dan takikardia untuk meminimalkan terjadinya perdarahan. Laki-laki usia 17 tahun dengan diagnosa penurunan kesadaran cedera kepala 2x4 karena perdarahan intracranial subdural hemorrhage (SDH) regio frontotemporoparietal sinistra dan edema cerebri hari ke 4 disertai herniasi subfalcine ke kanan dengan hemofilia A direncanakan tindakan trepanasi dekompresi evakuasi SDH. Pasien mendapatkan injeksi faktor VIII 4000 unit sebelum operasi. Durante operasi perdarahan 1100cc dan mendapat transfusi 1940cc produk darah hingga hemodinamik stabil. Post operatif pasien dilakukan perawatan di ICU selama 8 hari, dilakukan extubasi setelah kondisi membaik.Perioperative Management Trepanation and Decompression Subdural Hemorrhage with Haemophilia AAbstractHaemofilia A is congenital blood disease with female carrier, usualy found in male patient and happened for life. When one coagulation factor is lost or disfunction, coagulation mechanism will be disturbed and the bleeding difficult to stop. In this day, brain injury caused by trauma is the first cause of death in patient with haemophilia. Surgery in intracranial bleeding must be done as much as possible to get better prognosis. Blood evacuation must undergo quickly but very risky for rebleeding. Factor VIII must be given as soon as possible for treatment in severe haemophilia A patient with acute bleeding. Maintenance anesthesia also include decrease risk of hypertension and tachicardia for minimalize the ongoing bleeding. Male 17th years old diagnose with brain injury 2x4 caused by subdural hemorrhage (SDH) left frontotemporoparietal region and cerebral edema followed by subfalcine herniation to the right and haemophilia A planned for decompression evacuation of SDH. Patient got factor VIII 4000unit before operation. Intraoperative bledding are 1100cc and get 1940cc of blood product for stabilize the haemodynamic. Post operative was observe in Intensive Care Unit and went for extubation after 8th day after in good condition.

Efek Proteksi Otak Erythropoietin Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
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Eritropoietin (EPO) adalah hormon ginjal yang berfungsi mempertahankan jumlah eritrosit. Penelitian-penelitian menunjukkan bahwa EPO adalah molekul multifungsi yang dihasilkan dan digunakan oleh berbagai jaringan. Selain eritropoiesis. EPO juga terlibat pada respon biologis kerusakan jaringan akut dan subakut. Eritropoietin tidak hanya berperan dalam eritropoiesis tetapi juga memiliki efek proteksi otak dengan merangsang protein of repair, mengurangi eksitotoksisitas neuron, mengurangi inflamasi, menghambat apoptosis neuron dan merangsang neurogenesis dan angiogenesis pada penelitian eksperimental cedera iskemia, hipoksia dan cedera toksik. EPO juga memperbaiki outcome neurologik dan fungsi mental. Ditemukannnya EPO dan reseptor EPO (EPOR) di organ-organ dan jaringan non eritroid menunjukkan EPO mempunyai fungsi yang lain. Produksi ekstrarenal dari EPO ditemukan pada binatang pengerat dewasa dan pada manusia dengan severely anemic anephric masih ditemukan kadar EPO walau sangat rendah. Hal ini menunjukkan bahwa terjadi sintesa ekstrarenal dari EPO. Berbagai jenis sel pada sistem saraf pusat memproduksi EPO dan mengkespresikan EPOR. Mekanisme kerja EPO dapat mempengaruhi berbagai langkah dalam kaskade kematian sel. EPO dapat mencegah kematian sel neuron eksitotoksik yang diakibatkan oleh berbagai reseptor glutamat agonis juga melindungi sel neuron dari toksisitas yang diakibatkan oleh kainate, NMDA dan AMPA. EPO dapat melawan efek sitotoksik dari glutamat, meningkatkan ekspresi enzim-enzim antioksidan, mengurangi pembentukan radikal bebas, memperbaiki aliran darah serebral, mempengaruhi pelepasan neurotransmiter, dan meningkatkan angiogenesis. EPO tidak hanya berfungsi dalam proses eritropoiesis tetapi juga mempunyai efek protektor otak. Jalur proteksi otak dari EPO memang masih belum jelas tetapi penelitian-penelitian menunjukkan terdapat perbaikan dari otak baik secara klinis maupun laboratoris setelah pemberian EPO.Brain Protection Effect of ErythropoietinErythropoietin (EPO) has been viewed solely as a renal hormone with a specialized role in maintaining adequate numbers of erythrocytes. However, recent studies have revealed that EPO is a multifunctional molecule produced and utilized by many tissues. In addition to erythropoiesis, EPOs other key roles involve the acute and sub acute biological responses to tissue damage. Studies showed that EPO stimulates proteins of repair, diminishes neuronal excitotoxicity, reduces inflammation, inhibit neuronal apoptosis and stimulates both neurogenesis and angiogenesis. EPO also improved neurological outcomes and mental function. The discovery of EPO and EPOR (erythropoietin receptor) in many non-erythroid organs and tissues suggested that EPO has other roles. Extrarenal production of EPO found in adult rodents and in humans. Different cell types in the nervous system produce EPO and express EPOR. EPO mechanism influence every step in cascade of neuronal cell death. EPO prevents excitotoxic neuronal cell death caused by glutamate receptor agonists that protect neuron from toxicity from kainate, NMDA and AMPA. EPO can resist cytotoxic effect of glutamate, increased antioxidant enzymes expression, reduce free radical formation, repair cerebral blood flow, influence release of neurotransmitter dan angiogenesis. EPO function not only in erythropoiesis but also in brain protection. The brain protection pathway of EPO remains unclear but clinical and laboratory studies showed that good result.

Awake Endospine Disektomi pada Pasien Lumbar Spinal Stenosis karena Hernia Nucleus Pulposus Laras, Nuzulul Widyadining; Sasongko, Himawan
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
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Lumbar spinal stenosis (LSS) merupakan gejala penyakit yang berhubungan dengan berkurangnya ukuran canalis spinalis vertebra lumbal menyebabkan penekanan saraf yang terletak di dalamnya. Berdasar penyebabnya dibagi jadi dua, kongenital dan degeneratif. Pasien dapat merasakan fase nyeri yang tidak dapat diprediksi dan juga fase stabil tanpa nyeri. Salah satu contoh LSS degeneratif adalah pembengkakan diskus intervertebralis atau HNP. Penyakit HNP merupakan salah satu penyebab dari nyeri punggung bawah dan merupakan salah satu masalah kesehatan yang utama. Prevalensi HNP berkisar antara 12 % dari populasi. Terapi yang dilakukan salah satunya endospine disektomi. Operasi ini dapat dikerjakan dengan general anestesia (GA) atau neuroaksial anestesia (spinal, epidural). GA lebih dipilih karena lebih aman dari komplikasi gangguan jalur nafas. Deksmedetomidine memiliki efek sedasi tanpa risiko depresi respirasi serta memiliki efek analgesi dapat digunakan untuk metode awake endospine pada disektomi. Pada penulisan ini, dilakukan pemilihan teknik anestesi awake untuk mengakomodasi operator untuk menilai respon nyeri dan fungsi motorik pasien saat operasi.Awake Endospine Dissectomy in Patient with Lumbar Spine Stenosis caused by Hernia Nucleus PulposusAbstractLumbar spinal stenosis (LSS) are symptoms from degradation canalis spinalis vertebraes size which pressured nerve inside it. Based on its cause, there are two types of LSS, congenital and degenerative. The patient can experience an unpredictable pain phase as well as a stable phase without pain. Bulging of intervertebralis disc or HNP is one of degenerative LSS. HNP disease is one of the causes of low back pain and is a major health problem. HNP prevalention is 1-2 % from population. One of therapy use to medicate LSS is endospine discectomy. This operation done with general anesthesia (GA) or neuroaxial anesthesia (spinal, epidural). GA preferably used because it caused less side effect like airway obstruction or neural injury. Dexmedetomidine has a sedative effect without the risk of respiratory depression and has an analgesic effect. It can be used to awake endospine methods in dissectomy. In this case report, the writer did awake endospine method to accommodate operator so they could know level of pain and motoric function of patient durante operation.

Manajemen Anestesia pada Anak dengan Nasofrontal Meningoencephalocele dan Hydrocephalus Non-Communicant Wohon, Erfprinsi; Harijono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Meningoencephalocele adalah defek kongenital yang sangat jarang, tapi insidennya tinggi di Asia Tenggara, termasuk di Indonesia. Penderita dengan nasofrontal meningoencephalocele memerlukan koreksi pembedahan sedini mungkin karena adanya kelainan bentuk wajah, gangguan pandangan, bertambahnya ukuran meningoencephalocele disebabkan bertambahnya prolaps cerebri dan risiko infeksi. Dalam laporan ini kami presentasikan kasus seorang bayi 9 bulan dengan meningoencephalocele naso-orbital dan hydrocephalus non communican yang menjalani operasi VP shunt dan eksisi cele. Adanya massa tersebut, baik meningoencephalocele nasofrontal atau frontoethmoidal maupun occipital, menimbulkan kesulitan bagi ahli anestesi mulai saat induksi, pemeliharaan anestesi dan pasca operasinya. Menjadi tantangan bagi ahli anestesi dalam pengelolaan meningoencephalocele, dimana sebagian besar penderitanya adalah anak-anak yang mempunyai kesulitan tersendiri, termasuk mengamankan jalan nafas dengan intubasi dan adanya massa yang akan mempersulit ventilasi saat induksi, adanya massa pada nasofrontal serta nasoethmoidal yang berhubungan dengan komplikasinya dan penilaian yang tepat terhadap perdarahan dan hipotermia.Anesthesia Management for A child with Nasofrontal Meningoencephalocele and Hydrocephalus Non CommunicantMeningoencephaloceles are very rare congenital malformations in the world that have a high incidence in the population of Southeast Asia, include in Indonesia. Children with nasofrontal meningoencephaloceles should have surgical correction as early as possible because of the facial dysmorphia, impairment of binocular vision, increasing size of the meningoencephalocele caused by increasing brain prolapse, and risk of infection of the central nervous system. In this report, we presented a case of a 9 months-old baby girl with nasofrontal meningoencephalocele and hydrocephalus non communican, posted for VP shunt (ventriculo-peritoneal shunt) and cele excision. Because of the mass, nasofrontal or frontoethmoidal and occipital meningoencephalocele leads the anaesthetist to problems since the preoperative visit, time of induction, maintenance of anaesthesia during the operation until post operative care. Anaesthetic challenges in management of meningoencephalocele, which most of the patients are children, include ventilation, intubation and securing the airway with intubation with the mass in nasofrontal and nasoethmoidal with its associated complications and accurate assessment of bloodloss and prevention of hypothermia.

Manajemen Pasien Stroke Perdarahan Spontan dengan Komorbid Penyakit Paru Obstruktif Kronik yang Terjadi Bronkhospasme Intraoperasi Halimi, Radian Ahmad; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
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Stroke perdarahan spontan dan penyakit paru obstruktif kronik (chronic obstructive pulmonary disease/COPD) merupakan dua penyakit yang memiliki angka morbiditas dan mortalitas yang paling tinggi di dunia. Kondisi COPD akan meningkatkan resiko terjadinya stroke, selain itu dapat mengakibatkan terjadinya hipoksemia dan hiperkapnia. Seorang pria berusia 62 tahun datang ke unit gawat darurat karena mengalami penurunan kesadaran dan tidak dapat menggerakkan anggota tubuh sebelah kiri sejak 1 hari, pasien memiliki riwayat hipertensi namun tidak rutin meminum obat, pasien memiliki riwayat sering sesak, dan berdasarkan pemeriksaan fisik didapatkan kondisi barrel chest. Berdasarkan pemeriksaan CT-scan kepala didapatkan perdarahan intrakranial spontan pada basal ganglia sinistra. Pasien dilakukan tindakan kraniotomi evakuasi, namun 2 jam setelah dilakukan induksi anestesi terjadi kondisi desaturasi, hiperkapnia, peningkatan tekanan jalan nafas, dan ditemukan wheezing pada kedua lapang paru, kemudian diberikan terapi farmakologis dan non farmakologis untuk mengatasi kondisi bronkospasme. Pascabedah dilakukan pemanjangan ventilasi mekanik hingga pasien memenuhi kriteria untuk dilakukan ekstubasi. Penanganan pasien stroke dengan komorbid COPD membutuhkan pemahaman yang lebih mendalam mengenai interaksi otak dengan fungsi pernafasan akibat perubahan fisiologi dan patofisiologi pasien COPD.Management of Spontaneous Intracranial haemorhage with Comorbids Chronic Obstructive Pulmonary Disease Occurring Intraoperative BronchospasmAbstractStroke and chronic obstructive pulmonary disease (COPD) are the two diseases that have the highest morbidity and mortality rates in the world. COPD conditions will increase the risk of stroke, but it can lead to hypoxemia and hypercapnia. A 62-year-old man came to the emergency room because of a decreased consciousness and was unable to move the left limb since 1 day, the patient had a history of hypertension but did not regularly take medication, the patient had a history of frequent tightness, and based on physical examination was obtained barrel chest condition. Based on a head CT scan, spontaneous intracranial hemorrhage occurs in the left basal ganglia. Evacuation craniotomy was performed, but 2 hours after anesthesia induction occurred conditions of desaturation, hypercapnia, increased airway pressure, and wheezing was found in both lung fields, then given pharmacological and non-pharmacological therapy to overcome the condition of bronchospasm. After surgery, lengthening of mechanical ventilation is done until the patient meets the criteria for extubation. The treatment of stroke patients with co-morbid COPD requires a deeper understanding of brain interactions with respiratory function due to changes in physiology and pathophysiology of COPD patients.

Gambaran Epidemiologi Pasien Stroke Dewasa Muda yang Dirawat di Bangsal Neurologi RSUP Dr.Hasan Sadikin Bandung Periode 20112016 Syifa, Nadia; Amalia, Lisda; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
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Latar Belakang dan Tujuan: Kerugian akibat stroke lebih berat pada penderita yang berusia lebih muda dibandingkan usia tua. Insidensi stroke dewasa muda terus meningkat di berbagai negara. Pencegahan yang tepat dapat dilakukan dengan melakukan studi epidemiologi. Penelitian ini bertujuan untuk mengetahui gambaran epidemiologi pasien stroke dewasa muda.Subjek dan Metode: Penelitian ini merupakan studi kuantitatif dengan metode deskriptif. Data yang digunakan adalah resume rekam medis pasien stroke yang dirawat di bangsal neurologi Rumah Sakit Dr.Hasan Sadikin(RSHS) Bandung tahun 20112016. Data kemudian diklasifikasikan berdasarkan kelompok usia, jenis kelamin, tipe stroke, demografi, dan faktor risiko.Hasil: Sampel yang didapatkan sejumlah 450 buah. Jumlah kasus stroke terbanyak berada pada kelompok umur 4245 tahun (45,11%). Kejadian stroke iskemik (50,44%) lebih tinggi dibandingkan kejadian stroke perdarahan (49,56%). Kejadian pada perempuan (56,66%) lebih tinggi dibandingkan laki-laki (43,34%). Pendidikan terakhir penderita paling banyak adalah SMA (32,89%). Kelompok pekerjaan terbanyak adalah kelompok tidak bekerja (56,22%). Faktor risiko terbanyak adalah hipertensi (42,06%). Simpulan: Kejadian stroke dewasa muda di RSHS paling banyak terjadi pada kelompok usia 42-45 tahun, tipe stroke iskemik, jenis kelamin perempuan, pendidikan terakhir SMA, tidak bekerja, dan faktor risiko tertinggi adalah hipertensi.Epidemiological Picture of Young Adult Stroke Patients treated in Neurology Ward of RSUP Dr.Hasan Sadikin Bandung 20112016 PeriodBackground and Objectives: The stroke loss is higher in younger patients compared to the older patients. Stroke incidence is increasing year by year. Epidemiological study can be used as the basis of prevention and reduction of young adult stroke incidence. This study aims to determine the epidemiological picture of young adult stroke patientsSubjects and Method: This study is a quantitative study using descriptive method. The datas were taken from the resume of medical records of patients that are diagnosed as stroke and treated in the neurology ward Dr.Hasan Sadikin Hospital(RSHS) in 2011 - 2016. All samples were taken then classified by its age group, sex, stroke type, demographical characteristic and risk factor. Result: 452 samples were obtained. The highest number of cases are found in the 42-45 year old group (45,11%). Ischemic stroke (50,44%) cases are higher compared to the hemorrhagic stroke (49,56%). Stroke cases in women (56,66%) is higher than in men (43,34%). Most of the patients last education is high school (32,89%). Most of the patients who have stroke are unemployed (56,22%). The most risk factor is hypertension (42,06%). Conclusion: Stroke cases in RSHS happen to be higher in older age group, ischemic stroke type, women, high school as the last education, unemployment and the highest risk factor is hypertension.

Perbandingan Antara Fentanil 2 μg/kgBB/jam dan Scalp Block Terhadap Peningkatan Hemodinamik dan Kadar Glukosa Darah Sewaktu Saat Pemasangan Pin Kepala Pada Kraniotomi Robert Sihombing; Dewi Yulianti Bisri; Ruli Herman Sitanggang
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
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Latar Belakang dan Tujuan: Opioid dosis tinggi efektif memblokade nyeri pada operasi kraniotomi namun memiliki efek yang tidak diinginkan. Alternatif lain menggunakan teknik scalp block dikombinasikan dengan anestesi umum. Tujuan penelitian ini untuk membandingkan hemodinamik dan kadar glukosa darah sewaktu (GDS) antara fentanil 2 μg/kgBB/jam dan scalp block saat pemasangan pin kepala pada kraniotomi pengangkatan tumor elektif dengan anestesi umum. Subjek dan Metode: Penelitian ini dilakukan pada 28 pasien yang direncanakan pembedahan tumor otak elektif. Subjek penelitian dibagi menjadi dua kelompok: scalp block dan kelompok fentanil 2 μg/kgBB/jam. Tekanan arteri rerata, laju nadi dan kadar GDS intraoperatif dinilai dan dianalisis menggunakan uji-t berpasangan dan Chi-square.Hasil: MAP dan laju nadi antara kedua grup memiliki perbedaan signifikan (p0,05). Kelompok fentanil memiliki MAP dan laju nadi lebih tinggi dibanding dengan kelompok scalp block. Namun perbandingan kadar GDS antara kedua kelompok tidak menunjukkan hasil yang signifikan (p0,05).Simpulan: Scalp block lebih efektif dalam mengurangi peningkatan hemodinamik namun sama efektif dengan fentanil 2 μg/kgBB/jam dalam mengurangi peningkatan kadar GDS pada pasien yang menjalani operasi kraniotomi pengangkatan tumor elektif.Comparison Between Fentanyl 2 μg/kg/hr and Scalp Block of Hemodynamic Improvement and Blood Glucose Levels During Head Pin Installment in CraniotomyBackground and Objective: High dose opioids is one of the most effective techniques for blocking pain in craniotomy surgery but it has undesirable effect. Other alternative to overcome pain in craniotomy is using a scalp block technique in combination with general anesthesia. The aim of this study was to compare the increase of hemodynamic and blood glucose levels (BGL) between fentanyl 2 μg/kgBW/hr and scalp block during head pin installment in craniotomy surgery.Subject and Method: Twenty eight patients undergoing elective craniotomy tumor removal surgery were enrolled in the study. The patients were divided into two groups: scalp block and fentanyl 2 μg/kgBW/hr. Intraoperative mean arterial pressure (MAP), heart rate (HR) and BGL were recorded, and analyzed by paired t-test and Chisquare.Result: MAP and HR showed significant differences between groups (p0,05), wherein fentanyl group had higher MAP and HR than scalp block group. However, BGL during head pin installment did not show significant results between the two groups (p 0,05).Conclusion: Scalp block is more effective than fentanyl 2 μg/kgBW/hr in reducing increased of hemodynamic but equally effective with fentanyl in reducing increased of BGL during head pin installment in craniotomy tumor removal.

Penatalaksanaan Perioperatif Perdarahan Intraserebral Sandhi Christanto; Nazaruddin Umar; A Himendra Wrgahadibrata
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Perdarahan intraserebral spontan nontraumatik didefinisikan sebagai ekstravasasi spontan darah ke dalam parenkim otak yang dapat meluas ke ventrikel otak atau pada kasus yang jarang dapat sampai ke ruang subarachnoid. Perdarahan intraserebral merupakan penyakit yang sering dijumpai, di Amerika Serikat tiap tahunnya terdapat sekitar 37 ribu sampai 52 ribu orang mengalami perdarahan intraserebral.1,2 Tercatat sekitar 10–30% dari semua kasus stroke di rumah sakit merupakan akibat perdarahan intraserebral, angka mortalitas mencapai 30–50% pada 30 hari pertama perawatan dan hanya sekitar 20% pasien yang mendapatkan kembali kemampuan dan kemandirian fungsionalnya dalam jangka waktu 6 bulan.2,3,4Faktor resiko paling penting dan paling sering untuk PIS adalah hipertensi, yang rata-rata mencapai 60–70% dari semua kasus PIS.1,3 Seorang wanita, 41 tahun berat badan 60 kg datang dengan kesadaran menurun sejak 1 hari sebelum masuk rumah sakit disertai bagian tubuh sebelah kanan yang terasa lemas. Keluhan tersebut dirasa semakin lama semakin berat sampai keesokan harinya kesadaran makin menurun dan bagian tubuh kanan tidak bisa digerakkan. Pada pemeriksaan didapatkan jalan napas bebas, laju napas 18–20 x/menit, tekanan darah 200/100 mmHg, laju nadi 70x/menit, skor GCS E2M5V–, Hasil Ctscan menunjukkan adanya perdarahan intraserebral di basal ganglia kiri volume 52 ml dengan midLine shift ke kanan sejauh 1,1 cm, skor PIS 2. Keputusan kraniotomi evakuasi hematoma dilakukan untuk keselamatan pasien. Penatalaksanaan berkesinambungan dengan memperhatikan prinsip neuroresusitasi, neuroanestesia, neurointensive care serta neuroproteksi sangat penting dilakukan dalam menangani pasien dengan perdarahan intraserebral. Perioperative Management of Intracerebral HemorrhageSpontaneous non traumatic intracerebral hemorrhage is devined as an extravasation of blood into the brain parenchym that may extend into the ventricles and, in a rare case, to the subarachnoid space. Each year, approximately 37,000 to 52,000 people in the United States are suffered from an intracerebral hemorrhage. Intracerebral hemorrhage accounts for 10 to 30 percent of all cases of stroke with the 30-days mortality rate, ranges from 30%–50% and only 20% of survivors expected to have full functional recovery within 6 months. Hypertension is by far the most important and prevalent risk factor, directly accounted for about 60–70% of cases. A 41-year old woman weighted 60 kgs was admitted to the hospital with decreased level of conciousness and weak right side of her body, which became worsen in the next morning. On examination, airway was clear, respiratory rate was 18–20 x/min, blood pressure was 200/100 mmHg, heart rate was 70 bpm, GCS score was E2M5V–, CT-scan examination showed a 52 cc of intracerebral hemorrhage in left basal ganglia, mid line shifted 1,1 cm to the right and ICH score was 2. The decision of emergency hematoma evacuation was immediately made for life saving. Continuous and comprehensive management with neuro-resuscitation, neuroanestesia, neuro intensive care and brain protectio.

Pengelolaan Diabetes Insipidus dengan Cerebral Salt Wasting Syndrome dan Tension Pneumocephalus pada Pasien Pascabedah Eksisi Tumor Pineal Santosa, Dhania A; Rehatta, Nancy Margaretta
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Ketidakseimbangan elektrolit pada pasien pasca bedah saraf sering terjadi dan berpotensi menyebabkan cedera otak sekunder yang dapat memperburuk luaran pasien, sekalipun pembedahan sukses dilaksanakan. Diabetes insipidus merupakan disfungsi hipofisis yang menyebabkan hipernatremia. Kondisis ini sering terjadi pada kelainan hipofisis, namun jarang sebagai akibat tumor pineal. Seorang pasien laki-laki usia 21 tahun dengan diabetes insipidus prabedah menjalani pembedahan kraniotomi dan eksisi tumor pineal. Pada periode pascabedah pasien mengalami episode diabetes insipidus yang dipersulit dengan Cerebral Salt Wasting Syndrome dan Tension Pneumocephalus. Pemantauan ketat akan status volume, kadar gula dan elektrolit darah serta dosis desmopressin yang optimal merupakan kunci keberhasilan penanganan pasien ini sehingga tidak mengalami cedera otak sekunder. Seorang intensivis memegang peranan penting dalam pengelolaan pasien seperti ini terutama terkait patofisiologi kelainan intrakranial dan implikasinya terhadap keseimbangan cairan dan elektrolit.Management of Diabetes Insipidus Complicated by Cerebral Salt Wasting Syndrome and Postoperative Tension Pneumocephalus in a patient who underwent Pineal Tumor RemovalAbstractElectrolyte imbalance is an often incident in patients underwent neurosurgery and it potentially induces secondary brain injury, leading to a worse outcome, despite successful surgery. Diabetes insipidus is a frequent hypernatremic condition, commonly caused by abnormalities in the hypophysis; but rarely happens due to pineal tumor. A 21-year-old male with preoperative diabetes insipidus experienced episodes of diabetes insipidus complicated by cerebral salt wasting syndrome and tension pneumocephalus after a successful pineal tumor removal surgery. Closed observation on volume status, plasma glucose and electrolyte, along with optimal dose of desmopressin were keys of successful postoperative management in this patient in order to avoid the patient from secondary brain injury. An intensivist plays a key role, mainly in the understanding of intracranial pathophysiology and its implications to fluid and electrolyte balance.

Interaksi Otak-Paru pada Neurocritical Care Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Pasien cedera otak traumatik (COT) berat merupakan kasus trauma yang paling sering masuk ke ruang terapi intensif dan kemudian terjadi multiple organ dysfunction dengan morbiditas dan mortalitas yang tinggi. Disfungsi neurologik berat dihubungkan dengan terjadinya edema paru dan cedera paru yang akan memperburuk outcome, dapat terjadi pada cedera otak traumatik, subarachnoid hemorrhage, status epileptikus, dan mati otak. Ventilasi mekanis yang sering digunakan dalam pengelolaan pasien sakit kritis, juga dapat memicu respons paru dan organ lain termasuk otak akibat terjadinya inflamasi. Pengaruh dari paru ke otak terlihat bahwa kebanyakan pasien yang selamat dari acute respiratory distress syndrome (ARDS) menunjukkan kemunduran kognitif yang menetap saat dipulangkan. Mekanisme yang mendasarinya belum diketahui, tapi hiperglikemia, hipotensi dan hipoksia/hipoksemia di ICU secara nyata berkorelasi dengan outcome neurologik yang tidak baik tersebut. Sebaliknya, pengaruh dari otak ke paru terlihat bahwa sepertiga dari pasien COT terjadi acute lung injury (ALI), yang memperburuk outcome, tapi penyebabnya belum jelas, namun kemungkinan mekanismenya antara lain neurogenic lung/pulmonary edema, mediator inflamasi, infeksi nosokomial, dan efek buruk dari terapi neuroproteksi. Neurogenic pulmonary edema merupakan komplikasi cedera SSP yang telah dikenal dengan baik akibat pelepasan katekolamine masif. Sebagai simpulan pada pasien dengan cedera otak dan gagal nafas akut, pencegahan dari cedera otak iskemik dan penggunaan strategi proteksi paru yang hati-hati merupakan hal yang utama. Sejak cross-talk antara otak dan paru diketahui dapat terjadi melalui berbagai jalur yang berbeda, pengendalian variabel fisiologis merupakan hal penting untuk proteksi otak.Brain-Lung Interaction in Neurocritical CareSevere traumatic brain injury patient is one of the most frequent traumatic cases admitted to intensive care unit (ICU) and develop multiple organ dysfunction with high rate of morbidity and mortality. Severe neurological dysfunction associated with pulmonary edema and pulmonary injury which can further worsen clinical outcome has been observed in traumatic brain injury, subarachnoid hemorrhage, status epilepticus, and in brain death cases. Mechanical ventilation that is commonly used in the management of critically ill patients can also trigger pulmonary and other organs responses including the brain, in relation to the inflammation caused. The effect from lung to the brain can be seen by the fact that many acute respiratory distress syndrome (ARDS) survivors showed a persistent cognitive deterioration when discharge. The underlying mechanisms remains unknow, but hyperglycemia, hypotension and hypoxia/hypoxemia in ICU are significantly correlated with this unfavorable neurological outcome. On the other hand, the effect from brain to the lung can be seen by the fact that one-third of acute brain injury patients develop acute lung injury (ALI), that worsen the clinical outcome, but the cause remaining obscure. The possible mechanisms include neurogenic lung edema, inflammatory mediators, nosocomial infection, and the adverse effect of neuroprotective therapy. Neurogenic pulmonary edema is a well-recognized complication of central nervous system insult attributed to a massive catecholamine release. As conclusion in patient with brain injury and acute lung injury, prevention of inadvertent ischemic brain insult and the use of protective lung strategies are mandatory. Since the cross-talk between the brain and lungs may occurs through different pathway, greater control of physiological variables might be important to protect the brain.

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Home Page

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Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

Phone +6287722631615

Journal Mail Official jni@inasnacc.org

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

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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