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Jurnal Neuroanestesi Indonesia
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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Mortalitas Pasien Cedera Kepala Berat Berdasarkan Nilai Mean Arterial Pressure di RSUD Ulin Banjarmasin Januari 2018 Oktober 2021 Abidin, Zainal; Wibowo, Rama Anshori Putra; Illiandri, Oski; Gunawan, Steven; Husair, Ahmad; Sikumbang, Kenanga Marwan
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.529

Abstract

Latar Belakang dan Tujuan: Cedera kepala berat (CKB) memiliki angka kejadian sekitar 10% dari total cedera kepala, dengan angka mortalitas yang sangat tinggi. Nilai mean arterial pressure (MAP) dapat mempengaruhi mortalitas pasien karena gangguan perfusi otak. Penelitian ini bertujuan mengetahui mortalitas pasien CKB berdasarkan nilai MAP di RSUD Ulin Banjarmasi dari Januari 2018 Oktober 2021. Subjek dan Metode: Penelitian ini merupakan studi deskriptif retrospektif berupa pengambilan data rekam medik dengan teknik purposive sampling. Hasil: Sebanyak 51 pasien terdiagnosis CKB, meninggal sebanyak 72.5% dan hidup sebanyak 27.5%, Nilai MAP 50 mmHg kematian 100%, nilai MAP 150 mmHg kematian sebesar 77%. Rentang nilai MAP 50-150 mmHg memberikan angka kematian sebesar 62%. Nilai MAP pasien cedera kepala mempengaruhi angka kematian akibat gangguan tekanan perfusi otak yang tergantung pada tekanan intrakranial (TIK) dan MAP. Sirkulasi darah ke otak dipengaruhi oleh MAP. Tekanan perfusi otak yang adekuat mampu menurunkan angka mortalitas dan meningkatkan luaran hidup pasien.Simpulan: Nilai MAP mempengaruhi angka kematian pasien CKBMortality Severe Head Injury Patients Based on Mean Arterial Pressure at Ulin Hospital Banjarmasin Since Januari 2018-Oktober 2021AbstractBackground and Objective: Severe head injury has an incidence of about 10% of total head injuries, severe head injury has the highest mortality rate. In head injury patients, Mean arterial pressure (MAP) value can affect the patient's mortality rate related to brain perfusion. This research aims to know mortality of severe head injury patients based on the mean arterial pressure at Ulin Hospital Banjarmasin in January 2018 October 2021 period.Subject and Method: This research was retrospective descriptive study, with collected data from medical records using purposive sampling technique. Result: The results showed from 51 people diagnosed with severe head injury, death 72.5% and alive 27.5%. Mortality rate 100% with MAP 50 mmHg, 77% with MAP 150 mmHg. And in MAP 50-150 mmHg mortality rate about 62%. Measurement of MAP in patient with severe head injury affect the mortality rate related to brain perfusion which depends on intracranial pressure (ICP) and MAP. Mean arterial pressure affect cerebral blood flow. Adequate brain perfusion are factors to decrease mortality and increase survival outcome.Conclusion: mean arterial pressure affect mortality rate in patient with severe head injury
Masalah Respirasi pada Penderita Cedera Medula Spinalis Servikal Hermawan, Freddy; Harahap, Mohamad Sofyan
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.504

Abstract

Masalah pada sistem respirasi merupakan komplikasi yang sering menyebabkan morbiditas dan mortalitas pada pasien dengan Spinal Cord Injury (SCI) baik pada fase akut maupun kronik. Hal tersebut disebabkan adanya kelumpuhan otot-otot inspirasi dan ekspirasi yang motor neuronnya berasal dari nervus spinalis C3C5, melemahnya refleks batuk dan stagnansi sekret. Cedera tulang belakang servikal dapat terjadi baik langsung maupun tidak langsung, dapat menyebabkan defisit neurologis ataupun kematian. Cedera medula spinalis servikal terjadi 23% dari seluruh kejadian cedera dan 8,2% dari semua cedera yang menyebabkan kematian. Pada artikel ini disajikan kasus pasien dengan SCI setinggi C3C6, pasien menjalani operasi laminektomi dekompresi. Pascaoperasi pasien dirawat di ICU dikontrol menggunakan ventilator dengan mode Synchronized Intermittent Mandatory Ventilation (SIMV). Setelah pasien diekstubasi, saturasi turun, dari pemeriksaan fisik didapatkan ronkhi minimal, pasien didiagnosis dengan Hospital-Acquired Pneumonia (HAP) dan sepsis. Saturasi pasien membaik menjadi 99% setelah direintubasi disertai dengan program nebul combivent dan bisolvon 20 tetes/6 jam. Weaning ventilator pada pasien ditunda. Pasien diberikan vancomysin dan meropenem sebagai antibiotik definitif setelah dilakukan kultur bakteri.Respiration Problems in Cervical Spine Injury PatientsAbstractRespiratory complications associated with spinal cord injury (SCI) are the most important cause of morbidity and mortality in both the acute phase and a long-term perspective. This is due to paralysis of the inspiratory and expiratory muscles whose motor neurons originate from the C3C5 spinal nerves, weakened cough reflexes and stagnation of secretions. Cervical spinal cord injuries can occur directly or inderectly that can cause neurological disorder or death. Cervical injuries occur 23% of all cedera events and 8,2% of all cederas that cause of death. In this article, we present a case of a patient with SCI at C3C6, a patient undergoing decompressive laminectomy surgery. Postoperation, the patient was treated in the ICU controlled using a ventilator with Synchronized Intermittent Mandatory Ventilation (SIMV) mode. After the patient was extubated, the saturation dropped, on physical examination, there were minimal rhonchi, the patient was diagnosed with Hospital-Acquired Pneumonia (HAP) and sepsis. Patient saturation improved to 99% after reintubation accompanied by nebul combivent program and bisolvon 20 drops every 6 hours. Ventilator weaning in patient was delayed. The patient was given vancomycin and meropenem as definitive antibiotics after bacterial culture was performed.
Hubungan Strok dengan Gagal Ginjal Kronis: Laporan Kasus Bisri, Dewi Yulianti; Utama, M Lucky
Jurnal Neuroanestesi Indonesia Vol 12, No 1 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i1.534

Abstract

Masalah ginjal dapat meningkatkan risiko gangguan otak. Para peneliti menemukan hubungan yang kuat antara fungsi ginjal yang buruk dan penurunan aliran darah ke otak, semakin besar penurunan fungsi ginjal. Seorang laki-laki, 47 tahun, BB 50 kg, dengan diagnosis tumor ginjal sinistra end stage renal disease (ESRD), disertai infark lakunar cerebral, efusi pleura sinistra dan asma bronkial yang akan dilakukan nefrektomi. Riwayat hemodialisa rutin sejak 8 bulan, stroke infark 2 bulan lalu tanpa disertai kelemahan anggota gerak, asma bronkial terakhir serangan 1 tahun lalu. Induksi dengan fentanyl, propofol, atracurium, intubasi dengan pipa endotrahea no. 7,5 spiral, dan rumatan anestesi dengan sevoflurane 23 vol%, oksigen/N2O 50%, posisi flank. Operasi berlangsung selama 3 jam, dengan total perdarahan 2000 cc, pasien mendapatkan transfusi 1 PRC (189cc), cairan kristaloid 1000 cc, koloid 500cc. Dilakukan pemasangan chest tube thoracostomy (CTT) setelah pasien teranastesi. Dilakukan ektubasi di kamar operasi dan dipindahkan ke ruangan ICU, dirawat selama 2 hari sebelum dipindahkan ke ruang perawatan biasa. Gagal ginjal adalah faktor risiko untuk strok, yang merupakan penyebab utama morbiditas dan mortalitas. Risiko strok 530 kali lebih tinggi pada pasien dengan chronic kidney disease (CKD), terutama pada dialisis. Case fatality rate juga lebih tinggi mencapai hampir 90%. Oleh karena itu, penting untuk memahami faktor-faktor yang mempengaruhi strok pada populasi yang rentan ini untuk menerapkan strategi pencegahan dengan lebih baik.Relationship of Stroke with Chronic Renal Failure: Case ReportAbstractKidney problems can increase the risk of brain disorders. The researchers found a strong link between poor kidney function and decreased blood flow to the brain, resulting in a greater decrease in kidney function. A male, 47 years old, BW 50 kg, with a diagnosis of sinistra kidney tumor with end stage renal disease (ESRD), cerebral lacunar infarction, pleural effusion sinistra, asthma to be performed nephrectomy. History of routine hemodialysis since 8 months, stroke infarction 2 months ago without accompanied limb weakness, asthma with last exacerbation occurred 1 months ago. Induction with fentanyl, propofol, atracurium, intubation with endotracheal tube no. 7.5 spiral, and maintenance anesthesia with sevoflurane 2-3 vol% with 50% oxygen/N2O with the flank position. The operation lasted for 3 hours, with a total bleeding of 2000 cc, the patient got a transfusion of 1 PRC (189cc), crystalloid fluid 1000 cc, colloidal 500cc. Chest tube thoracostomy (CTT) installation is carried out after the patient is anesthetized. The patient was extubated in the operating room and transferred to the ICU and was care for 2 days before being transferred to the ward. Renal failure is a risk factor for stroke, which is the leading cause of morbidity and mortality. The risk of stroke is 5-30 times higher in patients with chronic kidney disease (CKD), especially on dialysis. The case fatality rate is also higher, reaching almost 90%. Therefore, it is important to understand the factors that influence stroke in this vulnerable population in order to better implement prevention strategies.
Managemen Anestesi untuk Seksio Sesarea dengan Strok Maternal Hemoragik Bisri, Dewi Yulianti; Lalenoh, Diana C
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.547

Abstract

Strok adalah penyebab utama ketiga morbiditas dan mortalitas di banyak negara maju. Penyakit serebrovaskular selama kehamilan dapat diakibatkan oleh tiga mekanisme utamaperdarahan, infark arteri, dan trombosis vena. Strok maternal bisa berupa iskemik atau hemoragik. Strok iskemik merupakan stroke yang umum terjadi disebabkan oleh hilangnya pasokan darah ke area otak. Strok hemoragik disebabkan oleh pendarahan ke otak akibat pecahnya pembuluh darah. Seksio sesarea atau intervensi bedah saraf yang harus diprioritaskan atau dilakukan secara bersamaan adalah masalah penting, sama seperti keputusan untuk menggunakan anestesi umum atau spinal dan epidural ketika akan dilakukan seksio sesarea. Teknik anestesi yang digunakan harus dibuat dengan mempertimbangkan risiko ibu secara keseluruhan. Hiperventilasi untuk mengurangi tekanan intrakranial (ICP) harus dijaga dalam kisaran 2530 mmHg karena kisaran normal PaCO2 selama kehamilan menurun menjadi 30-32 mmHg akibat peningkatan ventilasi dan progesteron. Selain itu, anestesi dalam yang berlebihan harus dihindari untuk mencegah ketidakstabilan hemodinamik. Penggunaan manitol untuk mengendalikan ICP, mempunyai risiko dehidrasi janin; sementara laporan lain menunjukkan bahwa 0,2 hingga 0,5mg/kg manitol tidak berpengaruh secara signifikan terhadap keseimbangan cairan janin. Pertimbangan khusus diperlukan untuk wanita dengan preeklampsia. Anestesi umum untuk seksio sesarea dikaitkan dengan peningkatan risiko strok jika dibandingkan dengan anestesi neuraksial pada wanita preeklamptik. Terlepas dari status preeklamptik ibu, pemeliharaan oksigenasi yang memadai dan stabilitas hemodinamik penting untuk keselamatan ibu dan janin.Anesthesia Management for Cesarean Section with Maternal Hemorrhagic StrokeAbstractStroke is the third leading cause of morbidity and mortality in many developed countries. Cerebrovascular disease during pregnancy can result from three main mechanismsbleeding, arterial infarction, and venous thrombosis. Maternal stroke can be either ischemic or hemorrhagic. Ischemic stroke is a common stroke caused by loss of blood supply to an area of the brain. Hemorrhagic stroke is caused by bleeding into the brain due to rupture of a blood vessel. Cesarean section or neurosurgical intervention should be prioritized or performed simultaneously is an important issue, as is the decision to use general anesthesia or spinal and epidural when a cesarean section is performed. The anesthesia technique used should be made taking into account the overall maternal risk. Hyperventilation to reduce intracranial pressure (ICP) should be kept in the range of 25-30 mmHg because the normal range of PaCO2 during pregnancy decreases to 30-32 mmHg due to increased ventilation and progesterone. The use of mannitol to control ICP, there are associated risks of fetal dehydration; While other reports show that 0.2 to 0.5mg/kg of mannitol has no significant effect on fetal fluid balance. Special consideration is needed for women with preeclampsia. General anesthesia for cesarean section is associated with an increased risk of stroke when compared to neuraxial anesthesia in preeclampsic women. Regardless of maternal preeclampic status, maintenance of adequate oxygenation and hemodynamic stability is important for maternal and fetal safety.
Diabetes Insipidus Pascaoperasi pada Pasien dengan Reseksi Tumor Kraniofaringioma Suarjaya, I Putu Pramana; Adhi Putra, Hendrikus Gede Surya; Sutawan, Ida Bagus Krisna Jaya
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.526

Abstract

Kraniofaringioma merupakan malformasi embrionik pada area sella dan parasella. Kraniofaringioma memiliki angka kesintasan yang tinggi, walaupun kualitas hidup pasien sering terganggu karena tumor terletak berdekatan dengan struktur anatomi penting seperti saraf optik, kiasma optik dan aksis hipotalamus-pituitari. Reseksi kraniofaringioma dapat mengakibatkan terjadinya diabetes insipidus. Diabetes insipidus (DI) ditandai terjadinya poliuri, dehidrasi dan hipernatremia yang disebabkan oleh defisiensi vasopresin atau antidiuretic hormone (ADH). Pasien laki-laki usia 20 tahun mengeluh poliuria, parestesia pada kedua tangan, pertumbuhan badan yang cepat dan nyeri kepala. Hasil Magnetic resonance imaging (MRI) kepala dengan kontras menunjukkan adanya tumor ekstraaksial supratentorial pada regio sisterna parasella. Pasien menjalani kraniotomi evakuasi tumor dengan anestesi umum dan tambahan blok scalp. Pascaoperasi pasien mengalami peningkatan volume urine sampai 400ml/jam dan dilakukan penggantian cairan dengan Ringerfundin dan D5 NS. Pasien mengalami DI dan pemberian vasopresin tetap dilanjutkan selama periode pascaoperasi sampai produksi urine 2ml/kg/jam. Manajemen perioperatif kraniofaringioma bertujuan mengendalikan tekanan intrakranial, mencegah cedera otak sekunder serta pemantauan pascaoperasi di ruang intensif untuk mengatasi komplikasi termasuk DI. Pada kasus ini terjadi poliuri dan peningkatan kadar natrium plasma akibat DI yang dapat diatasi dengan pemberian vasopresin pascaoperasi dan rehidrasi untuk mempertahankan kecukupan cairan serta menjaga keseimbangan kadar natrium plasma.Postoperative Diabetes Insipidus in Patient with Craniopharyngioma Tumor ResectionAbstractCraniopharyngioma is an embryonic malformation in the sella and parasella areas. Craniopharyngioma has high survival rate, although the patient's quality of life is often compromised due to tumors location near important anatomical structures such as the optic nerve, optic chiasm, and hypothalamic-pituitary axis. Craniopharyngioma tumor resection can provoke diabetes insipidus. Diabetes insipidus (DI) is characterized by polyuria, dehydration and hypernatremia due to vasopressin or antidiuretic hormone (ADH) deficiency. A 20 years old male patient complained of polyuria, paresthesia in both hands, rapid body growth, and headaches. Brain magnetic resonance imaging (MRI) with contrast revealed cystic mass in the parasella cistern region suggested craniopharyngioma. This patient underwent craniotomy tumor resection under general anesthesia and additional scalp block. Postoperatively the patient experienced an increased urine volume up to 400 ml/hour and fluid replacement was performed with crystalloids Ringerfundin and D5 NS. The patient suffered DI and vasopressin was continued in the postoperative period until urine output reduced to 2 ml/kg/hour. Perioperative management of craniopharyngioma is controlling intracranial pressure, prevent secondary brain injury and postoperative monitoring in the intensive care unit to manage potential complications such as DI. In this case, patient suffered polyuria and increased plasma sodium levels which was safely treated by administration of vasopressin and rehydration to maintain fluid adequacy and balance of plasma sodium levels.
Manajemen Anestesi pada Kraniotomi Pengangkatan Tumor Meningioma dengan Riwayat Operasi Kliping Aneurisma: Studi Kasus Firdaus, Riyadh; Omega, Andy; Lantang, Anastasia Magdalena; Yustisia, Fitria Isnarsandhi
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.549

Abstract

Eksistensi dari tumor otak beserta dengan aneurisma serebral sangat jarang terjadi, dengan estimasi kejadian 0,5-4,5%. Prioritas tatalaksana pembedahan pada dua patologi yang terjadi bersamaan ini belum jelas, di mana sering kali operasi pada aneurisma serebral didahulukan terlebih dahulu, sebelum dilakukan operasi pengangkatan tumor otak. Penanganan tumor otak pada pasien dengan riwayat kliping aneurisma memiliki tantangan tersendiri dalam bidang anestesi, di mana tindakan anestesi memiliki tujuan untuk menurunkan resiko ruptur aneurisma, mencegah iskemik serebral, serta mengoptimalkan fungsi sistemik dalam memfasilitasi prosedur surgikal. Studi kasus ini melaporkan perempuan 58 tahun dengan operasi pengangkatan tumor meningioma dengan riwayat kliping aneurisma. Operasi kliping aneurisma dilakukan 3 bulan sebelum dilakukan pengangkatan tumor otak. Pasien dengan klinis nyeri kepala dan pandangan mata kanan yang kabur, tanpa defisit neuorologis lainnya. Manajemen anestesi dilakukan dengan target tidak menaikan tekanan intrakranial, dengan analgetik adekuat, teknik relaksasi otak yang baik, serta pencegahan hiperkapnia, hipokapnia, serta hipoksia. Selain itu tekanan darah yang harus dijaga dengan mencegah terjadinya hipotensi ataupun hipertensi. Di akhir operasi, pasien diekstubasi dan melanjutkan perawatan lanjut di ruang rawat intensif. Pada pemeriksaan postoperasi pasien dengan kesadaran baik, tanpa kejang, serta tanpa defisit neurologisAnesthesia Management in Craniotomy Removal Tumor Meninigoma of Patient with History of Aneurysm Clipping Surgery: a Case ReportAbstractThe co-existence of brain tumors with cerebral aneurysms is extremely rare, with an estimated incidence of 0,5-4,5%. The priority for surgical treatment of these two pathologies is not clear, where surgery on a cerebral aneurysm is sometimes performed initially before surgical removal of brain tumor. Treatment of brain tumors in patients with a history of clipping aneurysm has its own challenges in the field of anesthesia, where anesthetic action has the goal of reducing the risk of aneurysm rupture, preventing cerebral ischemia, and optimizing systemic function while facilitating surgical procedures. This case study reports on a 58-year-old woman who underwent surgical removal of a meningioma tumor with a history of aneurysm clipping. Aneurysm clipping surgery was performed 3 months before brain tumor removal. Patient with clinical headache and blurred vision in the right eye, without other neurological deficits. Anesthetic management is carried out with the target of preventing further increase in intracranial pressure, with adequate analgesia, proper brain relaxation techniques, and prevention of hypercapnia, hypocapnia, and hypoxia. In addition, blood pressure must be maintained by preventing hypotension or hypertension. At the end of the operation, the patient was extubated and transffered to the intensive care unit. On postoperative examination the patient was conscious, without seizures, and without neurological deficits
The Trial of Org 10172 of Acute Stroke Treatment pada Era Pandemi COVID-19 Ayu, Auliya Putri; Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.530

Abstract

Latar Belakang dan Tujuan: Klasifikasi The Trial of Org 10172 of Acute Stroke Treatment (TOAST) diperkenalkan untuk mengklasifikasikan stroke iskemik berdasarkan mekanisme etiologi potensial. Tujuan dari penelitian ini adalah untuk menilai karakteristik pasien stroke iskemik akut berdasarkan klasifikasi TOAST pada era pandemi COVID-19.Subjek dan Metode: Penelitian ini adalah studi deskriptif dengan metode potong lintang, yang menggunakan data catatan medis pasien stroke iskemik akut yang dirawat di Departemen Neurologi Rumah Sakit Hasan Sadikin pada tahun 2021.Hasil: Sebanyak 136 pasien stroke iskemik akut terlibat pada studi ini. Large-artery atherosclerosis (LAA) adalah subtipe stroke yang paling umum (30,1%) dan hipertensi merupakan faktor risiko terbanyak (97%). Faktor risiko hiperkoagulasi ditemukan sebanyak 79% pada klasifikasi Undetermined etiology dan 100% pada klasifikasi Other etiology.Simpulan: Pada era pandemi COVID-19 ditemukan hiperkoagulasi sebagai faktor risiko dominan pada klasifikasi Undetermined etiology dan Other etiology. Mekanisme koagulopati pada COVID-19 dapat meningkatkan risiko stroke pada orang yang terinfeksi, yang memiliki faktor risiko stroke yang konvensional.The Trial of Org 10172 of Acute Stroke Treatment during Pandemic EraAbstractBackground and Objective: The Trial of Org 10172 of Acute Stroke Treatment (TOAST) classification was introduced to classify ischemic stroke based on potential etiological mechanisms. The purpose of this study was to assess the characteristics of acute ischemic stroke patients based on the TOAST classification during the COVID-19 pandemic era.Subject and Methods: This research was a descriptive cross-sectional study from the medical records of acute ischemic stroke patients who were treated in Neurology ward of Hasan Sadikin Hospital in 2021.Results: A total of 136 acute ischemic stroke patients were involved in this study. Large-artery atherosclerosis (LAA) was the most common stroke subtype (30.1%) and hypertension is the most common risk factor (97%). The risk factors for hypercoagulation were found to be 79% in the Undetermined etiology classification and 100% in the Other etiology classification.Conclusion: In the COVID-19 pandemic era, hypercoagulation was found as the dominant risk factor in the Undetermined etiology and Other etiology classifications. The coagulopathy mechanism in COVID-19 could increase the risk of stroke in affected person who have conventional stroke risk factors.
Hipotensi Berat Intraoperatif Tiba-Tiba saat Kraniotomi Pengangkatan Meningioma Bisri, Dewi Yulianti; Habibi, Muhammad; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.550

Abstract

Tekanan darah adalah perkalian cardiac output (CO) dengan systemic vascular resistance (SVR) dan CO ditentukan oleh stroke volume dan frekuensi denyut jantung. Seorang wanita usia 61 tahun, berat badan 49 kg, tinggi badan 154 cm, datang di rumah sakit Santosa Bandung Central dengan keluhan benjolan pada bagian belakang kepala sejak 3 tahun lalu dan semakin lama semakin bertambah besar. Tidak terdapat tanda-tanda peningkatan tekanan intrakranial dan defisit neurologis lainnya, di diagnosa meningioma dengan hipertensi, dilakukan pengangkatan tumor dalam posisi telungkup. Induksi dengan propofol, fentanyl, vecuronium bromida, lidokain, rumatan anestesi dengan sevofluran-oksigen/udara dan propofol serta vecuronium kontinyu. Intraoperatif terjadi 2 kali penurunan tekanan darah yang terjadi tiba-tiba, bradikardia dan desaturasi. Diberikan cairan dengan ringerfundin, gelofusin 1 L, darah Pack Red Cell (PRC) 2 unit, sulfas atropin, efedrin dan dilanjutkan dengan norepinephrine. Pascabedah dirawat 1 hari di Intensive Care Unit (ICU) dan kemudian 1 hari lagi di High Care Unit (HCU), kemudian pindah ke ruang perawatan biasa dan dirawat selama 3 hari sebelum dipulangkan dari rumahsakit. Penurunan tekanan darah hebat disertai bradikardia berat dan desaturasi tidak mungkin disebabkan karena perdarahan, tapi lebih mungkin dihubungkan dengan gangguan pada jantung. Terapi yang dilakukan dengan mengembalikan parameter tersebut ke nilai fisiologis sesegera mungkin. Sebagai simpulan, penurunan tekanan darah tiba-tiba disertai bradikardia dan desaturasi kemungkinan disebabkan karena terjadinya Bezold-Jarisch Reflexes (BJR).Sudden Intraoperative Severe Hypotension during Craniotomy of Meningioma RemovalAbstractBlood pressure is the multiplication of cardiac output (CO) with systemic vascular resistance (SVR) and CO determined by stroke volume and heart rate frequency. A 61-year-old woman, weight 49 kg, height 154 cm, came to Santosa Hospital Bandung Central in with complaints of a lump on the back of the head that has gotten bigger since 3 years ago and the longer it gets bigger. There were no signs of increased intracranial pressure and other neurological deficits, diagnosed with meningioma with hypertension, tumor removal was carried out in a prone position. Induction with propofol, fentanyl, vecuronium bromide, lidocaine, anesthetic treatment with sevoflurane-oxygen/air and propofol and continuous vecuronium. Intraoperative suddenly occurs 2 times decrease in blood pressure, bradycardia and desaturation. Given liquid with ringerfundin, gelofusin 1 L, blood pack red cells (PRC) 2 units, sulfas atropine, ephedrine and continued with norepinephrine. Post-dissected treated 1 day in the Intensive Care Unit (ICU) and then another 1 day in the High Care Unit (HCU), then moved to the ward and was treated for 3 days before being discharged from the hospital. Severe drops in blood pressure accompanied by severe bradycardia and desaturation are unlikely to be caused by bleeding, but are more likely to be associated with heart disorders. Therapy is carried out by returning these parameters to physiological values as soon as possible. As conclusion, a sudden drop in blood pressure accompanied by bradycardia and desaturation may be due to the occurrence of Bezold-Jarisch Reflexes (BJR).
Korelasi antara Skor ICH C-Reactive Protein, D-Dimer terhadap Luaran Pasien Perdarahan Intraserebral Irina, Rr Sinta; Indharty, Rr Suzy
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.541

Abstract

Latar Belakang dan Tujuan: Perdarahan intraserebral (Intracerebral hemorrhage/ICH) merupakan 10% hingga 15% dari semua stroke dan memiliki angka mortalitas dan morbiditas yang tinggi di dunia. Skor ICH valid untuk memprediksi derajat keparahan pasien perdarahan intraserebral yang dirawat di ICU. Kenaikan nilai C-reactive protein (CRP) menjadi prediktor terhadap hasil luaran pasien ICU. Tujuan penelitian adalah untuk mengetahui korelasi skor ICH, CRP dan D-dimer terhadap hasil luaran pada pasien perdarahan intraserebral.Subjek dan Metode: Subjek penelitian merupakan 27 orang pasien perdarahan intraserebral yang dirawat di ICU RSUP H. Adam Malik dan Rumah sakit Universitas Sumatera Utara. Pengambilan data secara consecutive sampling, kemudian diukur skor ICH, CRP, D-dimer dan dianalisa pemeriksaan tersebut dengan lama perawatan.Hasil: Dari total 27 pasien, 22 (81,5%) pasien pindah ruang rawat dan 5 (18,5%) pasien meninggal dunia. Rerata untuk skor ICH 2,70(0,67), CRP 1,41(0,72), dan D-dimer 2757,96(1230,73). Hasil korelasi antara skor ICH dengan lama rawatan dijumpai korelasi positif (r = 0,498; p = 0,008), didapatkan korelasi lemah antara CRP dengan lama rawatan (r = 0,315; p = 0,109) dan korelasi antara D-dimer dengan lama rawatan dan dijumpai korelasi positif (r = 0,546; p = 0,003).Simpulan: Didapati skor ICH, CRP dan D-dimer memiliki pengaruh terhadap lama rawatan pasien dengan perdarahan intraserebralCorrelation between ICH Score, C-Reactive Protein and D Dimer on the outcome of Intracerebral Hemorrhage PatientsAbstractBackground and Objective: Intracerebral hemorrhage (ICH) accounts for 10% to 15% of all strokes and has a high mortality and morbidity rate in the world. The ICH score is valid for predicting the severity of intracerebral hemorrhage patients treated in the ICU. The increase in C-reactive protein (CRP) value is a predictor in the outcome of ICU patients. The aim of this study was to find out how the ICH, CRP and D-dimer scores correlated with the outcome in intracerebral hemorrhage patients.Subjects and Methods: The subjects of this study were 27 patients with intracerebral hemorrhage who were treated in the ICU of H. Adam Malik Hospital and the University of North Sumatra Hospital. Data were collected using consecutive sampling, then ICH, CRP, D-dimer scores were measured and the examination was analyzed by length of stay.Results: Out of a total of 27 patients, 22 (81.5%) patients moved to the ward and 5 (18.5%) patients died. The mean for ICH score was 2.70(0.67), CRP was 1.41(0.72), and D-dimer was 2757.96(1230.73). The results of the correlation between ICH score and length of stay found a positive correlation (r = 0.498; p = 0.008), a correlation between CRP and length of stay had a weak correlation (r = 0.315; p = 0.109) and a correlation between D-dimer and length of stay and found a correlation positive (r = 0.546; p = 0.003).Conclusion: It was found that ICH, CRP and D-dimer scores had an effect on the length of stay of patients with intracerebral hemorrhage
Edema Paru Neurogenik Perioperatif Prihatno, MM Rudi; Suryani, Shila; Pramono, Wisnu Budi
Jurnal Neuroanestesi Indonesia Vol 12, No 2 (2023)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i2.464

Abstract

Edema paru neurogenik (EPN) merupakan salah satu penyebab kematian di ruang perawatan intensif. Kejadian ini lebih sering tersamarkan sebagai penyakit atau gangguan yang murni berasal dari sistem pernafasan. Pemeriksaan untuk menegakkan diagnosis EPN perlu dilakukan, baik secara radiologis dan laboratoris. Ada beberapa hal yang sangat berguna pada penentuan perkiraan kejadian EPN ini, antara lain adalah penyebab kejadian neurologis yang terjadi, pemeriksaan penunjang, lama perawatan berjalan di RS, serta prakondisi penyakit penyerta yang dimiliki oleh pasien ataupun keluarganya. Pasein yang akan menjalani prosedur operasi dan memiliki gangguan respirasi sebelumnya atau riwayat gangguan neurologis sebelumnya atau bahkan keduanya, menjadi catatatan tersendiri akan resiko kejadian EPN perioperatif. EPN pada dasarnya bisa ditatalaksana dengan baik bilamana dalam pengelolaannya secara komprehensif dan selalu mempertimbangkan kemungkinan diagnosa banding kausatifnya, karena bila salah dalam penentuan diagnosanya, maka tentunya akan mengakibatkan kesalahan dalam terapinya.Pengelolaan EPN yang efektif dan efisien, didasarkan pada tegaknya diagnosis yang diperkuat dengan dukungan pemeriksaan laboratorium dan penunjang, untuk menyingkirkan kerancuan penyebab dari EPN, apakah murni kasus neurologis ataupun non neurologis. Pasien pasca pembedahan yang terindikasi mengalami EPN, selama perawatan di ruang perawatan intensif ataupun ruangan perawatan pasca anestesi (post anesthesia care unit/ PACU), perlu mendapatkan perhatian khusus untuk sementara waktu, dengan tujuan agar pasien tidak mengalami pemburukan.Perioperative Neurogenic Pulmonary EdemaAbstractNeurogenic pulmonary edema (NPE) is one of the leading causes of death in the intensive care unit. These events are often disguised as diseases or disorders that originate purely from the respiratory system. Diagnostic examination of NPE needs to be done, both radiologically and in the laboratory. Several things are useful in determining the estimated incidence of NPE, including the causes of neurological events, supporting examinations, length of stay, and preconditions for comorbidities owned by the patient or his family. Patients who are about to undergo a surgical procedure and have previous respiratory problems, a recent history of neurological disorders, or even both have a special note about the risk of perioperative NPE events. Management of NPE can be appropriate if it is managed comprehensively and always considers possible differential diagnoses of causes because if it is wrong to make a diagnosis, then of course it will result in an error in therapy. Effective and efficient management of NPE, based on diagnosis that is strengthened by the support of laboratory and supporting examinations, to rule out ambiguous causes of NPE, both purely neurological and non-neurological cases. Postoperative patients who are indicated to have NPE, during treatment in the intensive care unit or post anesthesia care unit (PACU), need to receive temporary special attention so that the patient does not experience aggravation.

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