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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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Comparison of Changes in Cortisol Levels in the Blood of Patients Undergoing Craniotomy Using Continuous Infusion Lidocaine and Fentanyl Syaputra, Adhika; Irina, Rr Sinta; Lubis, Andriamuri Primaputra; Harahap, Juliandi
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.565

Abstract

Background and Objectives: Craniotomy is a surgical procedure that involves part of the skull, temporarily removing it to expose the brain and carrying out intracranial procedures. The surgery can be considered as the standard model for assessing cortisol as a stress response. Cortisol in the blood can cause hemodynamic and physiological changes in the body such as increased heart rate, increased blood pressure, and also increased blood sugar levels. Some literature showed that continuous infusion of fentanyl and lidocaine - has an effect in maintaining the responses to stress, namely the level of cortisol in the blood. The aim aimed to determine the comparison of changes in cortisol levels in the bloodpatients undergoing craniotomy using continuous infusion lidocaine and continuous infusion fentanyl.Subject and Method: This research used a double-blind randomized controlled trial (RCT) with a pre-test and post-test with a control group design. This study divided the samples into 2 groups. Continuous infusion of lidocaine and continuous infusion of fentanyl were then checked for cortisol levels in the patient's blood before and after undergoing craniotomy.Results: The result of 28 samples that underwent craniotomy, 6 samples were excluded, so the total number of samples analyzed was 22 samples. Differences in mean cortisol levels before and after surgery in the lidocaine and fentanyl groups were 193.90 nmol/L and 153.90 nmol/L respectively with a P value of 0.021.Conclusion: In the study, it was found that cortisol levels increased in both fentanyl and lidocaine groups after a craniotomy. There is a significant difference between the two groups of fentanyl and lidocaine, where statistically the fentanyl group was better at maintaining blood cortisol levels after craniotomy than the lidocaine group.
Neuroanesthesia Management in Cavernous Sinus Meningioma Craniotomy Patients Rozi, Fakhriyadi; Prihatno, MM Rudi; Cahyono, Iwan Dwi
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.583

Abstract

AbstractThe most prevalent primary cavernous sinus (CS) lesion is cavernous sinus meningioma (CSM). Of all intracranial neoplasms, 1% are tumors in CS, and 41% are CSM. For contemporary neurosurgeons, orbital involvement in cavernous sinus meningiomas (CSMs) poses special difficulties. The condition is known as cavernous sinus meningioma (CSM) gradually impairs vision and may ultimately result in chiastic compression. Since January 2023, a male 55-year-old had been admitted to the hospital with cephalgia and mild diplopia in his right eye. Cavernous meningiomas were discovered using CT scans, and a craniotomy procedure was scheduled to remove the tumor. In order to facilitate intubation, the patient was given a premedication of sufentanyl for analgesia and was then given general anesthesia. Rocuronium was used to relax the muscles. Desflurane is an attractive option available to anesthesiologists to maintain general anaesthesia. This surgical procedure of removing intracranial tumours requires proper induction and monitoring of the patient's condition during surgery to prevent increased intracranial pressure. Intracranial elevation can cause systemic changes such as hypertension and changes in heart rhythm, as well as cerebral artery spasm, and lead to cerebral infarction and cerebral ischemia. An effective neuroanesthesia management program can help preserve hemodynamic stability and improve results during craniotomy surgery for the removal of meningiomas.
Endotracheal Intubation without Neuromuscular Blocking Agent in Patient with Fracture Cervical Spine C1 and C4 Underwent Fusion C12 and C46 Suarjaya, I Putu Pramana; Purwanto, Osmond; Aldy, Aldy; J. Sutawan, Ida Bagus Krisna
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.584

Abstract

About 30% of cervical spine fractures involve injuries to the C1 and C2 vertebrae, which are considered unstable. Ensuring the stability of the injured cervical spine throughout perioperative period, including preoperative examinations, anesthesia induction, laryngoscopy, and intubation, is crucial for anesthesiologists. A 40-year-old woman suffered neck pain following a motorcycle accident, suffering a Spinal Cord Injury ASIA Impairment Scale (SCI AIS) E, a fracture of the C5 vertebral body (CV) classified as AO Spine Type A2, a Jefferson Type IV fracture, and mild head trauma. She underwent surgical fusion of the C1C2 and C4C6 vertebrae under general anesthesia, which included dexmedetomidine, propofol, sevoflurane, and fentanyl without any neuromuscular blocking agents (NMBA). The primary goal of perioperative airway management in cervical injury is a secured airway, while maintaining cervical stability without inflicting secondary injury. The cervical muscle group is essential for maintaining cervical stability, and the use of NMBA may jeopardize this stability, necessitating external cervical stabilization, especially during laryngoscopy and intubation. Induction agents in combination with opioid, widely used to facilitate laryngoscopy and intubation without using NMBA. Anesthesiologists must precisely arrange the management of cervical spine injuries patient to avoid secondary injury and improve surgical outcomes.
Anesthesia Management for Evacuation of Cerebral Abscess in Geriatric Patient with Myasthenia Gravis Suarjaya, I Putu Pramana; Purwanto, Osmond; Wundiawan, Kristian Felix; J. Sutawan, Ida Bagus Krisna
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.585

Abstract

A Cerebral abscess is an intracranial focal abscess which is a life-threatening emergency. Myasthenia gravis is an autoimmune disorder caused by antibodies targeting the neuromuscular junctions post-synaptic receptor. A seventy-three-year-old male, with an intra-axial tumor in the frontoparietal region underwent craniotomy for abscess evacuation. The Patient also has a history of hypertension and myasthenia gravis under treatment of dexamethasone and pyridostigmine. Anesthesia induction was performed with thiopental, opioid analgesics with fentanyl, neuromuscular blocking agent (NMBA) with rocuronium, and scalp block. The Patients depth of neuromuscular block was monitored with a Train-of-Four (TOF). Surgery was performed in a supine position, duration of surgery was 4.5 hours. The Patient was extubated in the operating theatre, monitored in the intensive care unit, and discharged home on the nineteenth day. Anesthetic management in geriatric patients with cerebral abscesses accompanied by myasthenia gravis has become complex due to the interaction of disease state, medical treatment, anesthetic drugs especially neuromuscular blocking agents, and surgical stress. The Patient was at risk for residual paralysis and had high sensitivity to nondepolarizing neuromuscular blocking agents, so the use of train-of-four (TOF) was very helpful for extubating this patient safely.
Perioperative Management Patients with Meningioma C1-2 Bisri, Dewi Yulianti; Indrayani, Ratih Rizki; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 13, No 1 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i1.587

Abstract

Removal of spinal meningiomas in cervical 1 and 2 has several problems, especially regarding the respiratory and cardiovascular systems. A woman, 33 years old, admit Santosa Bandung Central Hospital with complaints of weakness in her left hand and both legs since 4 months ago. Weight 50 kg, height 155 cm, blood pressure 146/102 mmHg, pulse rate 105 x/min, temperature 36.50C, SpO2 98% with room air. At diagnosis of cervical myelopathy due to space occupying lesion (SOL) intradural meningioma suspect. Induction of anesthesia with fentanyl 100 mcg, propofol 60 mg, rocuronium 40 mg, ventilated with 100% oxygen and sevoflurane 3 vol% (1.5 MAC), before laryngoscopy-intubation repeated half the initial dose of propofol. The patient is intubated in an in-line position. Anesthesia maintenance with sevoflurane 1 vol%, oxygen: air 50%, dexmedetomidine continuous 0.4 mcg/kg per hour, and continuous rocuronium 10 mcg/kgBW/min. Ventilation is controlled with a tidal volume of 360 ml, frequency 14 times/min. Then the patient is positioned in the prone position. Post-surgery is admitted to the ICU and day 5 the patient can be discharged from the hospital. The effects of C12 spinal cord tumors can affect the respiratory and cardiovascular systems. Surgical trauma can aggravate the injury before recovery occurs, so it is necessary to do ventilation assistance and cardiovascular support before recovery.
Malnutrition in Acute Stroke: An Article Review Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.536

Abstract

The prevalence of malnutrition after stroke varies widely. It is estimated about one-fifth of patients with acute stroke are malnourished on initial hospital admission, while the prevalence of malnutrition ranges from 6.1 to 62%. Energy requirements increase due to stress caused by stroke, while food intake decreases due to impaired ability to eat, so the body will use its fat and protein stores as fuel to produce glucose. Muscle and fat tissue undergo degradation due to the breakdown of amino acids to form energy. Systemic consequences occur after stroke, peripheral immunodepression in association with overstimulation of the autonomic and neuroendocrine systems. Damage to cerebral tissue can activates the hypothalamus-pituitary-adrenal axis, resulting in increased levels of glucocorticoid hormones, catecholamines, and glucagon, leading to hypermetabolism (increased energy use), hypercatabolism (increased protein breakdown), and persistent hyperglycemia. The prevalence of malnutrition increases with the length of stay and decreased functional improvement during rehabilitation. Malnourished patients with stroke experience a higher stress reaction, which increases the occurrence of peptic ulcers, and infections of the respiratory and urinary tracts, thus extending the length of stay and increasing mortality.
Dexmedetomidine as Neuroanesthesia Management in Patient with Meningioma Craniotomy Kumoro, Mohammad Aji; Prihatno, MM Rudi; Kartinofan, Aditya Pradana
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.592

Abstract

Meningiomas are the type of tumour that grows from the protective membranes of the brain, which line both the brain and spinal cord. The incidence rate of meningioma between females and males is 2:1 and tt is a fairly common neurosurgical case at Margono Soekarjo General Hospital Purwokerto. Dexmedetomidine is the drug of choice used for sedation and analgesia. In various literature, it is said that the use of dexmedetomidine will reduce hemodynamic fluctuations during surgery. A 49-year-old man was hospitalized because of cephalgia and hemiparesis of his left extremity. Computed tomography scan revealed a solid tumour at parietooccipitalis region, lobulated, measuring 7,2 x 7,1 x 4,4 cm, and an increase in intracranial pressure. General anesthesia was administered, beginning with premedication using sufentanil for analgesia, followed by induction with thiopental, and rocuronium for muscle relaxation to facilitate intubation. Dexmedetomidine is an attractive option available for anesthesiologist for maintaining general anesthesia. In this surgical procedure to remove an intracranial tumor, appropriate induction and monitoring of the patient's condition during surgery is required to prevent the risk of increasing intracranial pressure. Dexmedetomidine reduces cerebral blood flow, decreases intracranial pressure, reduces the rate of cerebral oxygen metabolism, and maintains cerebral perfusion pressure. Good management of neuroanesthesia supports the maintenance of hemodynamic stability and leads to better outcomes in craniotomy surgery. Dexmedetomidine has benefits on maintenance of anaesthesia in neurosurgical procedures.
Comparison of Changes in Rso2 in Midazolam and Propofol Sedation Post Craniotomy in the Icu of H. Adam Malik Hospital Pratama, Dicko Kanugrahan; Irina, Rr Sinta; Winata, Ade
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.579

Abstract

Introduction: Cerebral oxygen saturation reflects tissue perfusion in the cerebrum. Decreases in cerebral oxygen saturation are linked to longer hospital stays and cognitive impairment. Midazolam and propofol can decrease cerebral blood flow through decreasing the cerebral oxygen metabolic rate. The purpose of this research is to analyze the comparison of changes in cerebral oxygen saturation after midazolam and propofol administration in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan.Subject and Method: This is a randomized control trial study. Patients were divided into, Midazolam group, that given an initial dose of 0.05 mg/kg followed by a maintenance dose of 0.02-0.10 mg/kg/hour and Propofol group that given sedation with a dose of 0.3-3mg/kg/hour, with the target of the 2 groups being a Richmond Agitation-Sedation Scale (RASS) value of 0 to -2. Data analysis using unpaired T test.Results: The results for cerebral regional oxygen saturation and RASS between groups showed significant differences in right and left value (p 0.001), but there was no significant difference in RASS (p0.05) between each group at each measurement time. The results of the analysis of cerebral regional oxygen saturation and RASS between times, there was no significant difference in right and left value (p0.05), but there was a significant difference in RASS (p0.001) at each measurement time. Based on the results of the analysis carried out, it is known that there is no statistically significant difference in changes in cerebral regional oxygen saturation both right and left in changes in RASS because it is found that all data have p0.05.Conclusion: There is no change in right and left for cerebral regional oxygen saturation after administration of propofol and midazolam groups with RASS value 0 to -2 in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan
Dexmedetomidine Administration does not Affect Electrocorticography Reading during Epilepsy Focal Removal Surgery Nauli, Anggarian Oloan; Harahap, M Sofyan
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.591

Abstract

Epilepsy prevalent across all ages and genders, making it one of the most widespread neurologic disorder. Worldwide, 20-40% of epilepsy patients are refractory or resistant to oral anti-epileptic drugs, requiring surgery to treat their seizures. The use of electrocorticography (ECoG) can help determine the focus of epilepsy and requires anaesthetic drugs that do not affect the electroencephalography (EEG) readings during surgery. The aim of this case was to study the effect of using dexmedetomidine (DEX) as additional to maintenance anesthesia in epileptic craniotomy surgery with ECoG. A 28-year-old man came to the hospital with complaints of recurrent seizures, generalized tonic-clonic type seizures that lasted 2-3 minutes, was unconscious during the seizure, fell asleep afterwards, and recurred 2-3 times a day. The patient had suffered from epilepsy since 4 years ago. Physical and supporting examinations were within normal limits. Head MSCT examination with contrast suspected oligodendroglioma. The patient was administered dexmetomidine while underwent epilepsy craniotomy surgery with ECoG to remove the tumor which was suspected to be the epileptic focus. The choice of anesthetic agent in epilepsy craniotomy, especially when involving ECoG modalities, requires special consideration to improve intraoperative quality and postoperative outcomes. Propofol is the most widely used induction agent. However, these agents have anticonvulsant effects and activate non-specific spike waves in large areas of the brain. This has the potential to interfere with spike wave monitoring with ECoG. The use of dexmedetomidine has been shown to produce a stable hemodynamic effect and does not affect the ECoG readings. The use of DEX as an adjuvant in anesthesia maintenance does not inhibit spike waves during surgery, so ECoG can be used effectively for anesthesia in craniotomy operations with ECoG
Anaesthetic Management for Patient with Trigeminal Neuralgia underwent Microvascular Decompression (MVD) Hardian, Rapto; Pratama, Edwin; Tarigan, Dwi Septwo Rustaminta; Sikumbang, Kenanga Marwan
Jurnal Neuroanestesi Indonesia Vol 13, No 2 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i2.600

Abstract

Trigeminal neuralgia (TN) is a chronic pain with repeated brief episodes of electric shock-like pain affecting the fifth cranial nerve. Microvascular decompression (MVD) is one of treatments for TN. Anesthetic management for MVD requires special consideration to reduce brain volume (slack brain) and optimise Mean Arterial Pressure (MAP). Female 29-yo, 40kgbw with chief complaint: throbbing pain and intermittent stiffness in right facial area since 1 year ago. Brain MRI examination showed crossing of right superior cerebellar artery (RSCA) branch with right trigeminal nerve near the root entry zone and underwent MVD. Anesthesia using smooth intubation technique and maintenance using a combination of inhalational anaesthetics (sevoflurane 1 vol%) and intravenously (propofol 100mcg/kg/minute, remifentanil 0.2mcg/kgbw/min, and rocuronium 10mcg/kgbw/min). Target for MAP (90mmHg) and EtCO2 (30mmHg). We didn't use mannitol for slack brain. Early emergence with smooth extubation to prevent sudden haemodynamic changes and minimising coughing then for early neurological detection of intracranial complications.The combined use of sevoflurane 1MAC and continuous propofol provides optimal visualisation of the operating area. This combination reduces cerebral blood flow which makes the brain slack and keeps MAP optimal to maintain cerebral perfusion pressure and reduce the risk of cerebral ischemia. The combination of these agents also makes early recovery for more rapid neurological assessments. Anaesthesia management for MVD uses neuroanesthesia principles, balanced anaesthesia, and strict haemodynamic monitoring. The combination of inhalation anaesthetic sevoflurane and intravenous propofol gave optimise visualisation in the operation area and the patient's recovery can be enhanced

Page 32 of 36 | Total Record : 354

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