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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 354 Documents
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Manajemen Perioperatif untuk Pemulihan Dini Pascaoperasi pada Kraniotomi Evakuasi Tumor Supratentorial: Sebuah Laporan Kasus Suarjaya, I Putu Pramana; Supradnyana, I Nyoman Novi; Johanes, Kevin Paul; 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.v12i2.546

Abstract

Early Recovery After Surgery (ERAS) merupakan suatu upaya pemulihan dini pascaoperasi yang masih terus dikembangkan untuk operasi bedah saraf. Upaya ERAS pada tumor otak supratentorial akan memberi keuntungan pemulihan fungsional pascaoperasi lebih cepat dan masa perawatan yang lebih singkat. Pasien wanita 45 tahun, dengan tumor ekstraaksial regio fronto-temporal kiri dengan diagnosa meningioma parasagital sinistra menjalani operasi kraniotomi evakuasi tumor. Pasien sadar penuh, mengeluh sakit kepala hilang timbul, pandangan kabur dan memiliki riwayat kraniotomi evakuasi tumor sebelumnya. Pasien menjalani kraniotomi dengan anestesi umum dan tambahan blok scalp. Operasi berlangsung selama 3 jam 20 menit dengan hemodinamik yang stabil selama anestesi dan pembedahan. Pascaoperasi, pasien segera diekstubasi dan dirawat di ruangan intensif selama 2 hari. Pasien pulang pada hari kelima dan kontrol rawat jalan. Penatalaksanaan perioperatif pada pasien tumor supratentorial yang menjalani kraniotomi pengangkatan tumor dapat dilakukan untuk memfasilitasi pemulihan dini pascaoperasi. Manajemen multidisiplin yang tepat pada tahap praoperasi, intraoperasi dan pascaoperasi, dengan mempertimbangkan penyakit penyerta pasien, penting untuk keberhasilan melakukan pemulihan dini pascaoperasi.Perioperative Management to Facilitate Early Recovery After Surgery for Supratentorial Tumor Resection: A Case ReportAbstractEarly Recovery After Surgery (ERAS) in neurosurgery is a promising and developing concept directed to enhance postoperative recovery for neurosurgical patient. ERAS application to supratentorial brain tumor patients will provide advantage of early functional recovery and shorter length of stay. We reported a successful anesthetic management for a 45-year-old woman, diagnosed with a left frontotemporal extra axial tumor, suspected left parasagittal meningioma. Preoperative, patient was fully conscious but complained occasional headache and blurred vision with normal hemodynamic parameters. We performed general anesthesia with additional scalp block for this patient to facilitate the surgery, which lasted 3 hours 20 minutes. The surgery went uneventful with a stable hemodynamic, patient was extubated in the operating theatre and monitored in the Intensive Care Unit (ICU). After two days in the ICU, we transferred the patient to the ward. She was discharged on the fifth day and controlled as an outpatient care. Perioperative management of patients with supratentorial tumor whom undergo craniotomy for tumor removal could be performed to facilitate early recovery. Appropriate multidisciplinary management in the preoperative, intraoperative and postoperative periods, with regard to the underlying disease, is important to successfully perform the ERAS
Teknik Anestesi Bebas Opioid dalam Mendukung Konsep ERAS pada Kraniotomi Reseksi Tumor Metastasis Otak Krisna J. Sutawan, Ida Bagus; Suarjaya, I Putu Pramana; Juwita, Nova; Prabowo, Pratama Yulius
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.543

Abstract

Teknik anestesi bebas opioid (opioid free) semakin sering digunakan akhir-akhir ini untuk menurunkan komplikasi pascaoperasi yang berkaitan dengan konsumsi opioid. Dilaporkan keberhasilan penanganan anestesi dengan teknik opioid free pada wanita usia 61 tahun yang dilakukan kraniotomi reseksi tumor metastasis. Pada pemeriksaan preoperatif didapatkan kesadaran pasien compos mentis, tekanan darah 150/80 mmHg, nadi 72 kali/menit, reguler, frekuensi nafas 24 kali/menit, suhu badan 36,6 C, saturasi oksigen 99%. Sebelum induksi pasien diberikan nebulisasi lidokain 4%, diberikan sedasi menggunakan propofol Target Controlled Infussion (TCI) Target Effect 0,5 1 mcg/ml dan deksmedetomidine kontinu sebelum dilakukan pemasangan pemantauan akses intraarteri (arterial line). Induksi anestesia dilakukan dengan TCI propofol 3,5-4 mcg/ml, dilanjutkan dengan injeksi lidokain 4% melalui suntikan pada membran kriko-tiroid sebelum dilakukan intubasi. Pemeliharaan dilakukan dengan sevofluran 0,5-1 MAC, O2, compressed air (FiO2 50%), Target Controlled Infusion (TCI) propofol serta deksmedetomidine kontinu. Operasi berlangsung selama tiga setengah jam, pasien berhasil diekstubasi dan dipindahkan ke ruang intensif. Pasien dirawat selama 1 hari di intensive care unit (ICU) dengan kombinasi analgetik parasetamol 1 gram dan deksketoprofen 25 mg tiap 8 jam intravena. Teknik opioid free pada kraniotomi mendukung konsep Enhanced Recovery After Surgery (ERAS) pada operasi bedah saraf, namun tentunya harus dengan penggunaan agen multimodal dalam hal anestesi maupun analgesi yang bisa dimulai sejak preoperatif hingga pascaoperatif.Opioid Free Anesthetic Technique in Supporting the ERASConcept in Brain Metastatic Tumor Resection CraniotomyAbstractOpioid-free anesthetic techniques are increasingly popular lately to reduce postoperative complications associated with opioid consumption. Reported the success of opioid free techniques in a 61-year-old woman who underwent craniotomy resection of metastatic tumors. On preoperative examination, level of consciousness was compos mentis, blood pressure 150/80 mmHg, pulse 72 beats per minute, respiratory rate 24 times/minute, body temperature 36.6 C, oxygen saturation 99%. Prior to induction, patient was nebulized with 4% lidocaine, sedation was used for inserting the arterial line with target controlled infusion (TCI) propofol 0.51 mcg/ml and dexmedetomidine continuously. Anesthesia induction was performed by increasing the TCI to 3.54 mcg/ml, followed by injection of 4% lidocaine at the cricoid membrane before intubation. Maintenance was carried out with sevoflurane 0.51 MAC, O2, compressed air (FiO2 50%), TCI propofol and dexmedetomidine continuously. The surgery lasted three and a half hours, the patient was successfully extubated and transferred to the intensive care unit. The patient was treated for 1 day in the ICU with an analgesic combination of 1 gram paracetamol and 25 mg dexketoprofen every 8 hours intravenously. Opioid free technique in craniotomy supports Enhanced Recovery After Surgery (ERAS) concept in neurosurgery, but the usage should be with analgesia and anesthesia multimodal agents, preoperatively until postoperatively
Penanganan Ventilasi Pascaoperasi pada Penderita Tumor Intradural Ekstradural Medula Spinalis Servikal 1-3: Sebuah Laporan Kasus Syahril, Chandra Patrya Putra; Tri C, Rizky Rahmad; Anindita, Eliezer Iswara; Harahap, M Sofyan
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.572

Abstract

Pendahuluan: Reseksi bedah tumor sumsum tulang belakang dapat menimbulkan tantangan yang signifikan dalam manajemen jalan napas. Sebagian besar pasien yang menjalani reseksi tumor sumsum tulang belakang dikelola melalui intubasi endotrakeal, nafas kendali selama operasi, dan bantuan ventilasi pascabedah. Kasus: Perempuan 43 tahun datang dengan mengeluh nyeri leher belakang dirasakan menjalar sampai dengan kedua telapak kanan terutama sisi kiri, kemudian pasien mengeluh kelemahan semua anggota gerak yang dirasakan sepanjang hari dan membuatnya kesulitan untuk beraktivitas sehari-hari. Rasa kesemutan dirasakan dari kedua ujung jari kaki hingga ke leher depan. Pasien menjalani operasi kraniotomi far lateral approach sisi kiri dan eksisi tumor, operasi berlangsung selama 7 jam 30 menit dengan hemodinamik yang stabil selama anestesi dan pembedahan. Pascaoperasi dilakukan bantuan pernapasan dengan ventilator di ICU dan dilakukan pengecekan laboratorium darah rutin, blood gas arterial (BGA) dan elektrolit. Setelah hari ke dua pipa endotrkeal dapat dilepas dan pasien kembali ke ruangan biasa. Pasien pulang pada hari kelima dan kontrol rawat jalan. Diskusi: Manajemen anestesi pada kasus tumor medula spinalis servikal, membutuhkan perhatian khusus, terutama bantuan ventilasi pasca operasi. Dengan pemantauan yang baik dan penyesuaian ventilasi sesuai kebutuhan, pasien dapat segera disapih dari ventilator. Kesimpulan: Penatalaksanaan anestesi pada pasien yang menjalani operasi tumor sumsum tulang belakang bersifat kompleks. Diperlukan pemahaman lengkap tentang jenis tumor, lokasi, dan efek massa dalam manajemen ventilasi pada pasien paska operasi tumor medulla spinalis.Postoperative Ventilation Management in Patients with Cervical Spinal Cord Intradural and Extradural Tumors 1-3 : a Case ReportAbstractIntroduction : Surgical resection of spinal cord tumors can pose significant challenges in airway management. Most patients undergoing spinal cord tumor resection are managed via endotracheal intubation, controlled ventilation during surgery and post operative ventilation support. Case: A 43 year old woman came in complaining of back neck pain that spread to both right palms, especially the left side, then the patient complained of weakness in all limbs felt throughout the day and making it difficult for her to carry out daily activities. A tingling sensation is felt from the tips of the toes to the front of the neck. The patient underwent a left-sided far lateral approach craniotomy and tumor excision, the operation lasted 7 hours 30 minutes with stable hemodynamics during anesthesia and surgery. Post-operatively, ventilation was supported with a ventilator in the ICU and laboratory checks were carried out including routine blood, arterial blood gas (BGA) and electrolytes. After the second day the endotrcheal tube can be removed and the patient returns to the normal room. The patient went home on the fifth day and was outpatient control. Discussion: Anesthetic management in cases of cervical spinal cord tumors requires special attention, especially postoperative ventilation assistance. With good monitoring and ventilation adjustments as needed, patients can be quickly weaned from the ventilator. Conclusion: Anesthetic management in patients undergoing surgery for spinal cord tumors is complex. A complete understanding of tumor type, location, and mass effect is needed in ventilation management in post-operative spinal cord tumor patients.
Kejadian dan Manajemen Nyeri Pascaoperasi Bedah Saraf Pediatri di RSUP Prof. I.G.N.G. Ngoerah Denpasar Suarjaya, I Putu Pramana; Muliadi, Win; Hengky, Hengky; Santo, Budi; Yani, Jancolin Yani; Chandra, Steven Okta; J Sutawan, Ida Bagus Krisna
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.544

Abstract

Latar Belakang dan Tujuan: Nyeri pascaoperasi sangat penting dalam upaya pemulihan dini pascaoperasi. Penelitian observasional ini bertujuan untuk mengetahui kejadian dan manajemen nyeri pascaoperasi bedah saraf pada populasi pediatri di RSUP Prof. I.G.N.G. Ngoerah Denpasar.Subjek dan Metode: Pasien pediatri yang menjalani operasi bedah saraf dilakukan pencatatan data demografis, regimen analgetik pascaoperasi dan penilaian derajat nyeri saat berada di ruang pemulihan, jam ke-6, 12, 24, dan 48 pascaoperasi. Uji Wilcoxon digunakan untuk menilai kemaknaan penurunan derajat nyeri pascaoperasi.Hasil: Penelitian ini yang dilakukan pada 37 pasien pediatri pascaoperasi bedah saraf mendapatkan rerata usia pasien 91 bulan, sebagian besar laki-laki, rerata berat badan 28 kilogram, rerata tinggi badan 115 sentimeter, paling banyak dengan diagnosis hidrosefalus komunikans, paling banyak dilakukan operasi ventrikulo-peritoneal shunt, dengan rerata durasi operasi 165 menit, serta paling banyak dengan teknik anestesi umum. Uji statistik Wilcoxon mendapatkan penurunan bermakna (p0,05) derajat nyeri pasien pediatri pascaoperasi seiring waktu saat berada di ruang pemulihan, jam ke-6, 12, 24, dan 48 pascaoperasi.Simpulan: Manajemen nyeri pascaoperasi bedah saraf pediatri pada subyek penelitian telah berjalan baik, tidak didapatkan adanya pasien mengalami nyeri sedang dan berat pascaoperasi, walaupun modalitas manajemen nyeri yang digunakan beragam.Incidence and Post-Operative Pain Management on PediatricPatients Underwent Neurosurgery at Prof. I.G.N.G. Ngoerah Hospital DenpasarAbstractBackground and Objective: Postoperative pain management is important for early recovery after surgery. This observational study aims to determine the incidence and management of postoperative pain in pediatrics underwent neurosurgery at Prof. I.G.N.G. Ngoerah General Hospital Denpasar.Subject and Methods: Demographic data, postoperative analgesic regimen, and pain score while in the recovery room, on the 6th, 12th, 24th, and 48th hours postoperative were recorded. The decreased in pain score analyzed by Wilcoxon signed-rank test with significant value p0.05 Results: This study which included 37 pediatric patients whom underwent neurosurgery, found patients have average age of 91 months, mostly male, average weight of 28 kilograms, average height of 115 centimeters, with most diagnosis were communicating hydrocephalus, the most performed surgery were ventriculoperitoneal shunt, with average operating time of 165 minutes, and with most anesthetic techniques used were general anesthesia. The Wilcoxon statistical test found a significant (p0.05) decreased in the postoperative level of pain over the time from in the recovery room, on the 6th, 12th, 24th, and 48th hours postoperative.Conclusion: Postoperative pain management in pediatric patients underwent neurosurgery at Prof. I.G.N.G. Ngoerah Hospital, Denpasar was acceptable. There was no subject experiencing moderate and severe postoperative pain.
Diabetes Insipidus pada Pasien Pascaoperasi Tumor Hipofisis Cahyanti G, Ramadina Putri; Nofiyanto, Eko; Laksono, Buyung Hartiyo
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.553

Abstract

Pembedahan pada tumor hipofisis dapat menyebabkan penurunan fungsi hipofisis, salah satunya adalah defisiensi antidiuretic hormone (ADH) yang dapat menyebabkan diabetes insipidus. Laporan kasus: Pasien perempuan 48 tahun, dengan diagnosis tumor sella-suprasella disertai visual loss, hipotiroid, hipoprolaktin, dan hipokortisol. Operasi berjalan 4 jam dengan tatalaksana general anestesi teknik proteksi otak. Pasca operasi pasien mengalami diabetes insipidus dengan klinis poliuriaa sampai lebih dari 6000 cc perhari. Dilakukan perawatan intensif dengan pemantauan ketat di Intensive Care Unit (ICU). Penggantian cairan dan pemberian desmopressin acetate kombinasi dengan vasopressin dilakukan sebagai terapi. Setelah perawatan 12 hari terjadi perbaikan klinis dan laboratoris. Tatalaksana dan monitoring yang tepat akan kejadian diabetes insipidus yang dapat mencegah terjadinya perburukan kondisi pada pasien.Diabetes Insipidus in Patient with Postoperative Pituitary TumorAbstractSurgery on a pituitary tumor can cause a decrease in pituitary function,: like deficiency antidiuretic hormone which cause diabetes insipidus. Case report: A 48-year-old female patient, with a diagnosis of sella-suprasella tumor accompanied by visual loss, hypothyroidism, hypoprolactin, and hypocortisol. The operation lasted 4 hours under general anesthesia with brain protection techniques. Postoperatively the patient had diabetes insipidus with clinical poliuriaa up to more than 6000 cc per day. Intensive care is carried out with close monitoring in the Intensive Care Unit. Fluid replacement and administration of desmopressin acetate in combination with vasopressin is performed as therapy. After 12 days of treatment, there was clinical and laboratory improvement. Appropriate management and monitoring of the incidence of diabetes insipidus can prevent the worsening of the patient's condition.
Diagnosis dan Tatalaksana Neuralgia Trigeminal Eksaserbasi Akut Terkini Hermawan, Asep Nugraha
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.473

Abstract

Neuralgia trigeminal (NT) ditandai oleh adanya nyeri seperti sengatan listrik singkat unilateral berulang, terbatas pada distribusi satu atau lebih cabang saraf trigeminal, onsetnya muncul dan berhenti tiba-tiba, dan dipicu oleh rangsangan yang normalnya tidak memunculkan rasa nyeri. Diagnosis NT adalah diagnosis klinis sesuai dengan kriteria diagnosis the International Classification of Headache Disorders. Pemeriksaan penunjang seperti Magnetic Resonance Imaging (MRI) dan tes elektrofisiologi diperlukan untuk menentukan etiologi. Etiologi NT penting untuk diketahui karena pendekatan terapi yang berbeda. Pada NT eksaserbasi akut terjadi peningkatan intensitas nyeri dan frekuensi serangan yang sangat tinggi. Kondisi ini menyebabkan anoreksia dan dehidrasi karena asupan makanan dan minuman akan memicu serangan nyeri. Perawatan di rumah sakit diperlukan untuk rehidrasi, pemeliharaan nutrisi, tatalaksana nyeri akut dan pengaturan dosis obat anti-konvulsan sebagai pencegahan nyeri atau sampai dilakukan tindakan lain seperti pembedahan atau neuroablatif sesuai indikasi.Acute Exacerbation of Trigeminal NeuralgiaAbstractTrigeminal neuralgia (TN) is characterized by recurrent, brief unilateral electric shock-like pain, limited to the distribution of one or more branches of the trigeminal nerve, appearing and stopping suddenly, and triggered by stimuli that are normally painless. TN is a clinical diagnosis according to the diagnostic criteria of the international classification of headache disorders. Investigations such as magnetic resonance imaging (MRI) and electrophysiological tests are required to determine the etiology. It is important to know the etiology of NT because of the different therapeutic approaches. In acute exacerbations of TN, the pain intensity increases and the frequency of attacks is very high. This condition causes anorexia and dehydration because drinking or eating will trigger pain attacks. Hospitalization is needed for rehydration, nutritional maintenance, acute pain management and dose adjustment of anti-convulsant drugs as pain prevention or until other measures such as surgery or neuroablatives are carried out as indicated.
Perbandingan Kadar Interleukin-6 antara Pemberian Kombinasi Fentanil dan Midazolam Kontinyu dengan Deksmedetomidin Kontinyu pada Pasien Pascaoperasi Kraniotomi di Ruang ICU Munawar, Riza; Irina, Rr Sinta; Hamdi, Tasrif
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.557

Abstract

Latar Belakang dan Tujuan:Pembedahan kraniotomi dapat meningkatkan respon inflamasi tubuh akibat memprovokasi respon stres neuroendokrin. Interleukin-6 adalah salah satu parameter inflamasi memiliki hubungan yang erat pada inflamasi pasca operasi kraniotomi. Kombinasi fentanil dengan midazolam dan deksmedetomidin sebagai obat analgesia memiliki peran menghambat regulasi inflamasi sehingga bisa mengurangi pelepasan mediator inflamasi termasuk Interleukin-6. Tujuan penelitian untuk memperoleh hasil perbandingan pemberian kombinasi fentanil dengan midazolam dan deksmedetomidin terhadap kadar interleukin-6 pada pasien pasca kraniotomi di ruang ICUSubjek dan Metode:Penelitian menggunakan uji klinis double-blind randomized controlled trial (RCT) dengan 32 subjek penelitian yang setelah memenuhi kriteria inklusi dibagi secara acak menjadi 2 kelompok. Kelompok A mendapat kombinasi fentanil dan midazolam kontinyu dan kelompok B mendapat deksmedetomidin kontinyuHasil:Terdapat penurunan nilai rata-rata kadar interleukin-6 pada kelompok pemberian kombinasi fentanil dengan midazolam dan kelompok pemberian deksmedetomidin, namun secara statistik tidak memberikan nilai yang signifikan antara kedua kelompokSimpulan:Pemberian kombinasi fentanil dengan midazolam dan deksmedetomidin memberikan efek sebanding dalam menurunkan kadar Interleukin-6.Comparison of Interleukin-6 Levels between Continuous Combination of Fentanil and Midazolam with Dexmedetomidine Continuity in Postoperating Patients Craniotomy in ICUAbstractBackground and Objective: Craniotomy surgery can increase the body's inflammatory response by provoking a neuroendocrine stress response. Interleukin-6 as one of the inflammatory parameters has a close relationship with inflammation after craniotomy surgery. Combination fentanyl with midazolam and dexmedetomidine as anelgesia drugs have the role of inhibiting inflammatory regulation to reduce the release of inflammatory mediators including Interleukin-6. The aim of this study to compare the results of Combination fentanyl with midazolam and dexmedetomidine administration on interleukin-6 levels in post-craniotomy patients in the ICU room.Subjects and Methods: This study is an experimental study with The Pretest-Posttest Control Group Design, with a double blind randomized controlled trial (RCT) clinical trial where in this study two groups were divided. After obtaining approval from the Ethics Committee of the Faculty of Medicine, University of Sumatera Utara Medan, 32 research samples were collected, which after meeting the inclusion criteria were randomly divided into 2 groups. Group A received a combination of fentanyl and midazolam and group B received dexmedetomidine. The data obtained were tested using SPSS.Results: There was a decrease in the mean value of interleukin-6 levels in combination fentanyl with midazolam administration group and the dexmedetomidine administration group, but statistically did not provide a significant value between the two groups.Conclusion: Combination fentanyl with midazolam and dexmedetomidine administration have comparable effects in reducing Interleukin-6 levels.
Glial Fibrillary Acidic Protein sebagai Penanda Prognostik pada Stroke Iskemik Akut Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.446

Abstract

Stroke merupakan kegawatdaruratan neurologi yang timbul mendadak dan merupakan penyebab kematian nomor tiga terbanyak di negara dunia setelah penyakit jantung dan kanker. Stroke iskemik merupakan penyebab paling banyak yaitu 87% dari keseluruhan kasus stroke. Penanda biologik dibutuhkan untuk dapat menggambarkan kerusakan sel saraf otak sehingga dapat membantu klinisi untuk menegakkan diagnosis stroke iskemik. Salah satu penanda tersebut yaitu Glial Fibrillary Acidic Protein (GFAP) serum yang diekspresikan oleh sel glia otak yaitu astrosit. Astrosit merupakan sel glia yang terbanyak dalam sistem saraf pusat (SSP) yang berperan penting untuk menjaga fungsi fisiologis dan menjaga homeostasis otak. Astrosit adalah sel yang paling awal dan paling responsif bereaksi bila terjadi iskemia otak. Pada saat terjadi iskemia otak akan terjadi hipertrofi sel astrosit yang disebut sebagai proses astrogliosis sehingga GFAP diproduksi dan diekskresikan ke dalam aliran darah. Peningkatan kadar GFAP serum dengan sensitifitas 91% dan spesifisitas 97% menandakan reaktivitas sel astrosit dengan threshold cut off 0,29 ng/mL dan ditandai dengan memberatnya derajat defisit neurologis serta memperburuk luaran klinis pada pasien stroke iskemik akut.Glial Fibrillary Acidic Protein As Prognotic Marker In Acute Ischemic StrokeAbstractStroke is a neurological emergency that occurs suddenly and is the third leading cause of death in the world after heart disease and cancer. Ischemic stroke is the most common cause, namely 87% of all stroke cases. Biological markers are needed to describe the damage to brain nerve cells so that they can help clinicians to make a diagnosis of ischemic stroke. One of these markers is serum Glial Fibrillary Acidic Protein (GFAP) which is expressed by brain glial cells, namely astrocytes. Astrocytes are the most abundant glial cells in the Central Nervous System (CNS) which play an important role in maintaining physiological functions and maintaining brain homeostasis. Astrocytes are the earliest and most responsive cells to react when brain ischemia occurs. At the time of brain ischemia there will be hypertrophy of astrocyte cells which is referred to as astrogliosis process so that GFAP is produced and excreted into the bloodstream. Increasing GFAP levels with a sensitivity of 91% and a specificity of 97% indicates astrocyte cell reactivity with a threshold cut off of 0.29 ng/mL and is characterized by a worsening of the degree of neurological deficit and worsening of clinical outcomes in acute ischemic stroke patients.
Tatalaksana Kejang Intraoperatif pada Operasi Glioma dengan Tehnik Awake Craniotomy Sutaniyasa, I Gede; Firdaus, Riyadh; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 12, No 3 (2023)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v12i3.558

Abstract

Tehnik Awake Craniotomy (AC) untuk reseksi tumor glioma di area eloquent, menjadi pilihan untuk menghindari gangguan neurologis dan kognitif pascabedah. Perempuan, 34 tahun, diagnosa tumor intra-axial (high grade glioma), dengan keluhan kejang fokal pada tangan kiri sejak 4 bulan sebelumnya. Pemeriksaan MRI kepala dengan kontras ditemukan massa supratentorial intra-axial mengesankan suatu primary malignant brain tumor (high grade glioma). Dilakukan operasi AC dengan Monitored Consciuos Sedation (MCS), menggunakan dexmedetomidine dan scalps block. Selama operasi pasien mengalami 3 kali kejang, dari kejang fokal sampai kejang umum. Lama operasi 4 jam, reseksi tumor lebih dari 60%, operasi selesai karena pasien mengalami gangguan fungsi motorik pada ekstremitas atas dan bawah kiri. Pascabedah di rawat di ICU selama 2 hari, mengalami satu kali kejang pascabedah, dengan hemiparese sinistra grade 3. Kejang merupakan salah satu komplikasi yang paling sering dilaporkan pada prosedur AC. Kejang intraoperatif bisa menggagalkan AC, diganti ke anestesi umum dengan intubasi atau pemasangan laryngeal mask airway (LMA), dan kejang saat AC dikaitkan dengan meningkatnya morbiditas dan lama perawatan di rumah sakit Pemilihan pasien yang tepat, dukungan psikologis perioperatif, tim anestesi dan bedah yang berpengalaman memegang peranan penting dalam keberhasilan operasi dengan prosedur AC.Management of Intraoperative Seizures during Awake Craniotomy in Glioma Tumors AbstractThe Awake Craniotomy (AC) technique for resection of glioma tumors in the eloquent area is performed, while preserving neurological and cognitive functioning. Female, 34 years old, diagnosed with an intra-axial tumor (high-grade glioma), with complaints of focal seizures in the left hand since 4 months before. Head MRI examination with contrast found a supratentorial intra-axial mass suggesting a primary malignant brain tumor (high-grade glioma). AC surgery was performed with monitored conscious sedation (MCS), using dexmedetomidine and scalp blocks. During the operation, the patient had three seizures, ranging from focal seizures to generalized seizures. Operation time was 4 hours, tumor resection was more than 60%, and the operation was completed because the patient had impaired motor function in the left upper and lower extremities. Postoperatively, he was treated in the ICU for 2 days and experienced one postoperative seizure with grade 3 left hemiparesis. Seizure is one of the most commonly reported complications associated with awake craniotomy. Intraoperative seizure resulted in AC failures, requiring intubation or laryngeal mask airway change to to general anesthesia, and seizures during AC were associated with increased neurological short-term morbidity and a longer length of hospital stay. Selection of the right patient, perioperative psychological support, an experienced anesthetic and surgical team play an important role in the success of surgery with AC procedures.
The Relationship of Cortisol Levels and Sleep Quality in Acute Ischemic Stroke Patients: A Literature Review Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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.v13i1.533

Abstract

Hormonal factors are one of several elements that contribute to the process by which patients with acute ischemic stroke experience poor sleep quality. The hypothalamic-pituitary-adrenal (HPA) axis is responsible for producing the hormone cortisol. When the hypothalamus is activated, it releases vasopressin and Corticotropin Releasing Hormone (CRH), both of which influence Adrenocorticotropic Hormone (ACTH). This hormone triggers release of cortisol and other glucocorticoids by the adrenal glands. The HPA axis becomes engaged during an acute disease. Cortisol levels will rise as a result of HPA axis activation. Specifically, injury to the frontal or medial temporal lobes of the brain, as well as inflammation, or a lack of regulation of the HPA axis, can lead to this medical condition. Cortisol levels might remain elevated for up to seven days following the start of a stroke. An increase in cortisol levels is connected to an highly risk of stroke severity, length of hospital stay, and mortality in stroke patients. It is also an early warning sign of deteriorating sleep quality in patients with acute ischemic stroke.

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