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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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Prognosis of Surgical Management for Intracerebral Hemorrhage: Insights from Indonesia's National Brain Center Hospital Rahmatisa, Dimas; Lasanudin, Joshua Eldad Frederich
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.v13i1.588

Abstract

Background and Objective: Intracerebral hemorrhage (ICH), a stroke subtype that can be managed surgically, exhibits varying prognoses amongst countries. However, data for the Indonesian population are currently lacking. Subject and Methods: In a retrospective cohort study, medical records of post-surgical ICH cases in Rumah Sakit Pusat Otak Nasional from January 2021 to April 2023 were obtained. Prognostic data includes hospitalization duration, in-hospital mortality, and dependency upon discharge. Multivariate analysis was performed on sociodemographic and medical data to determine prognostic factors.Results: A total of 157 cases were obtained. Procedures performed include hemorrhage evacuation craniotomies (58.6%), burr holes (29.9%), ventriculoperitoneal shunts (24.2%), and decompressive craniectomies (5,1%), with 15.9% patients undergoing multiple surgical sessions. In-hospital mortality and total dependency occurred in 31.2% and 54.6% of patients, respectively. Average hospitalization is 16.32 days. Predictors for in-hospital mortality are age ? 50 years (p=0.002), male (p=0.014), hematoma volume 40mL (p=0.012), multiple surgical sessions (p=0.034), and presenting Glasgow Coma Scale (GCS) 9 (p=0.015). Predictors for total dependency are supratentorial lesions (p=0.025) and presenting GCS 9-12 (p=0.008) and 9 (p=0.002). Predictors for hospitalization 2 weeks are stroke onset 3.5 hours (p=0.008) and multiple surgical sessions (p=0.001). Conclusion: Surgical management of ICH in Indonesia reveals similar outcomes to other countries. However, differences in prognostic factors indicate potential variations between countries.
Perioperative Craniotomy Excision of Dextra Subtemporal Tumor with Thiopental, Sufentanyl and Invasive Monitor Perkasa, Guruh; Dwi Cahyono, Iwan; 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.v13i2.603

Abstract

Intracranial masses can arise from a variety of aetiologies, including congenital, neoplastic, infectious, or vascular processes, each requiring distinct diagnostic and management considerations. Establishing the presence or absence of intracranial hypertension is a critical component of the preoperative evaluation for patients undergoing craniotomy for mass lesions. Hemodynamic is an examination of the physical aspects of blood circulation, cardiac function and physiological characteristics of peripheral vasculature. A 74 year old man was admitted to the hospital because of cephalgia, and left limb weakness. Previously, the patient often felt headaches that came and went since six months ago. Three days before being admitted, the patient felt weak in his left limb and experienced decreasing in consciousness. The patient was given thiopental because the onset of action of thiopental was very short. Administration of intravenous doses of thiopental can cause cerebral vasoconstriction. Sufentanil was administered as an analgesic, because sufentanil is an opioid that has a rapid onset and analgesic potential, compared to fentanyl, intravenous and sufentanil is 510 times stronger. This efficacy to maintain adequate cerebral perfusion pressure (CPP), reduce cerebral blood flow (CBF), maintain normal autoregulation, reduce cerebral metabolic rate for oxygen (CMRO2). Arterial cannulation with continuous transduction is considered the gold standard for blood pressure monitoring during anaesthetic procedures. Rapid fluctuations in blood pressure can occur due to patient positioning, surgical manipulation, and the effects of anaesthetics drugs, and close monitoring of these changes is crucial for maintaining hemodynamic stability. The impact of anaesthetic management on CBF is also an integral component of neuroanesthesia, as increases in CBF are associated with increases in cerebral blood volume (CBV). An effective neuro-anesthesia management program that incorporates both invasive blood pressure monitoring and optimization of cerebral perfusion that can help preserving hemodynamic stability and improving outcomes for patients undergoing craniotomy surgery.
Correlation between Mean Platelet Volume, Fibrinogen and D-dimer with NIHSS Score Nasution, Putra Fajar; Irina, Rr Sinta; Lubis, Bastian
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.v13i2.581

Abstract

Introduction: Stroke is a clinical syndrome that develops rapidly due to focal or global brain disorders with symptoms last for 24 hours and potentially cause death. Due to the consideration that this Mean Platelet Volume (MPV) marker is not invasive, easy to do and is in line with the pathogenesis of stroke, researchers are interested in carrying out this research. And hopefully this research can provide information for the world of education and health about changes in MPV, fibrinogen and D-dimer in ischemic stroke patients. So it can be taken as consideration in the early management of ischemic stroke patients. Subject and Methods: This research was an observational study with a cross-sectional design at Haji Adam Malik General Hospital from October to November 2023. The research subjects were stroke patients who were treated in emergency room and met inclusion criteria. This research was to study about correlation of MPV, fibrinogen, and D-dimer with NIHSS scores of ischemic stroke patients. The method used in this research is the Pearson correlation test where data was normally distributed. All statistical tests with a p value 0.05 were considered significant. Results: The mean MPV was 10.4 1.6, while the mean NIHSS value was 19.9 8.7, and there was a statistically significant correlation between the MPV value and the NIHSS score (p0.05). The mean fibrinogen was 421.9 109.3, while mean NIHSS value was 19.9 8.7, and there was a statistically significant correlation between fibrinogen values and NIHSS scores (p0.001). The mean D-Dimer was 8.0 11.3, while the mean NIHSS value was 19.9 8.7, and showed a statistically significant correlation between D-Dimer value and NIHSS score (p0.05). The r value of MPV, fibrinogen, and D-dimer on NIHSS score was 0.494; 0.495; and 0.504. The regression coefficient for MPV variable is 0.093, therefore MPV variable influence on NIHSS variable is positive.Conclusion: There is a strong correlation between D-dimer and the NIHSS score, and a moderate correlation between MPV and fibrinogen with NIHSS score.
Thiopental-Dexmedetomidine as Adjuvant Anesthesia for Craniotomy Tumor Removal: A Case Report Bisri, Dewi Yulianti; Nuryanda, Dian; Alifahna, Muhammad Rezanda; Bisri, Tatang
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.v13i2.595

Abstract

Brain tumor surgery requires special anesthesia to get a slack brain and perform perioperative brain protection. The selected anesthetic drugs and adjuvants have the ability of anesthesia sparring effect and have a brain protective effect. Not many have done the combination of thiopental adjuvant with dexmedetomidine. The purpose of this case report is to see the effect of the combination of thiopental with dexmedetomidine as an adjuvant anesthesia on hemodynamics and slack brain and successful removal of brain tumors. A woman, 32 years old, with meningiomas had surgery to remove a brain tumor at Santosa Bandung Central Hospital. Preoperative examination showed blood lab results within normal limits, the presence of large meningioma and midline shift. Induction of anesthesia with thiopental 5 mg/kgBW, rocuronium bromide 0.9 mg/kgBW, fentanyl 3 mcg/kg and anesthetic maintenance with sevoflurane below 1.5 MAC, oxygen/air, continuous rocuronium 0.5 mg/kgBW/hour, thiopental and continuous dexmedetomidine. The anesthetic adjuvant used was thiopental 1-3 mg/kg/hour and continuous dexmedetomidine 0.40.7 mcg/kg/hour. A slack brain is obtained, and 90% of the tumor could be removed, and transfused during surgery 4 units pack red cells (PRC), crystalloid liquid as much as 2,500 cc, and colloidal fluid as much as 2,000 cc. The length of surgery is 11 hours. Post-surgery was treated in the ICU for 5 days, then moved to the ward for 2 days then the patient could be discharged from the hospital. The use of thiopental and dexmedetomidine continuously can produce slack brain and almost the entire tumor can be removed.
Comparison of Changes in Cortisol Values Before and After Administration of a Combination of Continuous Fentanyl and Paracetamol Drip in Post-Craniotomy Patients in ICU of Haji Adam Malik General Hospital Medan Etania, Cassandra; Irina, Rr Sinta; Ihsan, Muhammad
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.593

Abstract

Introduction: Post-craniotomy surgical pain can trigger an inflammatory response and release various stress response mediators. Prolonged stress response to pain can increase cortisol secretion which will eventually be resulted in cortisol dysfunction and widespread inflammation. Opioids have been shown to provide pain management after craniotomy. Fentanyl is a commonly used opioid analgesic to manage postoperative pain. The addition of paracetamol is often used as multimodal analgesia which aims to reduce postoperative pain and to minimize the stress response that occurs. The aim of the study was to obtain a comparison of changes in cortisol values before and after the administration of a combination of continuous fentanyl and paracetamol in post-craniotomy patients in the ICU of Haji Adam Malik General Hospital Medan. Subject and Methods: This research design used a cross sectional test with pretest and posttest design, with primary data sources obtained directly from examinations on patients in the ICU. This study involved 15 post-craniotomy patients in the ICU with mechanical ventilation. The cortisol levels in the patients blood were checked before and after administration continuous fentanyl and paracetamol drip. Results: There was a decrease in cortisol levels after being given a combination of continuous fentanyl and paracetamol drip in post-craniotomy patients by 18% with a p-value of 0.001 (p
Tetralogy Scalp Block Anesthesia without Opioid for Anesthetic Management in Children Undergoing Frontal Reconstruction Mahendratama, Muhammad Riza; Prihatno, M. Mukhlis Rudi; Wicaksono, Nugroho
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.640

Abstract

Traumatic brain injury (TBI) is one of the leading causes of death in developing countries, especially Indonesia. The incidence of TBI in Indonesia between 6% and 12% and has a mortality rate of 25% to 37%. Treatment of traumatic brain injury is done as soon as possible to improve quality of life and prevent further damage to brain cell and function. A 13-year-old child sustained mild traumatic brain injury and frontal fracture due to a fall from a motorcycle. The patient underwent frontal reconstruction in the operating room. The surgery was performed under regional anesthesia using a scalp block with an ultrasound device and without using opioid drugs. The surgery lasted about two hours without hemodynamic disturbances. The post-surgery Visual Analogue Scale (VAS) was 2-3. The patient was observed in the regular ward for four days and discharged without any disability. Scalp block was chosen to enhances analgesic quality without opioid, reduce requirement of ICU as well as hospitalization time, and save treatment costs. Opioids may cause respiratory and gastrointestinal depression and Postoperative Nausea and Vomiting (PONV).
Anesthetic Management of Craniotomy for Supratentorial Tumor Resection in a Patient with Femoral-Popliteal Deep Vein Thrombosis: Case Report Saputra, Tengku Addi; Halimi, Radian Ahmad; Hamzah, Hamzah
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.606

Abstract

Patients with brain tumors are highly susceptible to venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Approximately 2030% of those with intracranial tumors experience VTE, with factors such as neurological deficits, tissue factor secretion, genetic predispositions, advanced age, and hypertension contributing to the risk. In this case, a 61year woman with Space Occupying Lesion (SOL) Supratentorial at Midfrontal, Hypertension Stage II, Diabetes Mellitus (DM) type 2, and femoral-popliteal DVT undergoes craniotomy in general anesthesia. A thorough preoperative assessment is carried out to increase the success of anesthesia, including Doppler ultrasound assessment, administering anticoagulants up to 24 hours before surgery, and monitoring platelet levels and coagulation profiles. Managing VTE in these patients typically involves anticoagulants, thrombolytics, and thrombectomy tailored to the clinical situation. However, the use of anticoagulants, like heparin, poses a risk of severe bleeding during surgical procedures such as craniotomy. A craniotomy is associated with an increased risk of VTE due to endothelial damage, thromboplastin release, and post-operative immobilization, all contributing to Virchows Triad (venous stasis, endothelial injury, and hypercoagulability). Anesthesiologists must provide meticulous perioperative care, incorporating preoperative and post-operative anticoagulant prophylaxis and being aware of intraoperative bleeding. While VTE is recognized as a common post-operative complication, its impact during surgery and the strategies needed to mitigate related risks are still underexplored. Understanding and addressing these challenges are essential, particularly in patients undergoing craniotomy for intracranial tumors, to improve surgical outcomes and reduce mortality.
Tetralogy of Fallot with Sepsis Induced Coagulopathy in Case of Spontaneous Intracerebral Haemorrhage & Subarachnoid Haemorrhage Emas, Bagas; Winarso, Achmad Wahib Wahju; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.614

Abstract

Congenital heart disease is the most common cause of stroke in some children. A child aged 5 years 9 months came with complaints of decreased consciousness and shortness of breath, weight 23 kg and height 140 cm, blood pressure 140/95 mmHg, pulse 52x/minute, axillary temperature 36.7oC, respiratory rate 44x/minute and obtained SpO2 62%78% using a nasal cannula. The patient was diagnosed with Tetralogy of Fallot through echocardiography but it was not corrected, Intracerebral Haemorrhage & Subarachnoid Haemorrhage were discovered on a CT scan, and sepsis induced coagulopathy through other supporting examinations. Children with congenital heart disease (CHD) are more susceptible to infection, this occurs because there is an increased risk for children with congenital heart disease to experience severe complications due to common infections such as sepsis. Sepsis itself will cause a coagulopathy disorder called sepsis induced coagulopathy (SIC) whose mechanism is also based on sepsis. Each of tetralogy of Fallot and Sepsis induced coagulopathy have mutually supporting roles in the mechanism of intracerebral haemorrhage. Most ICHs are caused by hypertension, arteriovenous malformation (AVM), and aneurysm. The patient experiences left ventricular dilatation, this can cause a long-term condition of hypertension. Through the SIC mechanism it can cause systemic inflammation and vascular injury caused by mass production of inflammatory cytokines and their release into the circulation causing excessive activation of the clotting process, impaired fibrinolysis, and suppression of anticoagulant mechanisms which can cause endothelial dysfunction and thrombus formation.
Optic Nerve Pilocytic Astrocytoma in a Pediatric Patient: A Case Report Pramantara, I Made Stepanus Biondi; Niryana, I Wayan; Sista Satyarsa, Agung Bagus Sista; Golden, Nyoman; Mahadewa, Tjokorda Gede Bagus; Maliawan, Sri; Suarjaya, I Putu Pramana
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.594

Abstract

Pilocytic astrocytoma is a type of low-grade glioma that can develop in any part of the central nervous system. It primarily affects individuals in the pediatric and young adult age groups. Optic nerve pilocytic astrocytoma is an uncommon, gradually developing type of brain tumor known as a glioma. It is categorized as a grade I tumor by the World Health Organization (WHO). We aim to report rare optic nerve pilocytic astrocytomas and discuss their clinical findings and interconnection with the current literature. A 7-year-old male patient exhibited left-sided eye proptosis and complete loss of vision. A magnetic resonance imaging (MRI) performed before surgery showed the presence of a tumor in the left eye socket. The mass has a spherical shape and smooth boundaries, resulting in the compression of the left optic tract from behind. The left optic tract appears darker on T1-weighted images and brighter on T2-weighted images. On contrast administration, there is heterogenous contrast enhancement. A total resection of the mass was performed. Histopathology results show pilocytic astrocytoma (WHO Grade I). Optic nerve pilocytic astrocytoma is a tumor that can affect the optic nerve pathway. Early diagnosis and multidisciplinary team management are required. Treatment must be individualized, and the options include chemotherapy, radiotherapy, and surgical intervention. Surgery is only recommended in cases of painful or disfiguring proptosis and exposure keratopathy in eyes with severe vision impairment.
Levetiracetam as an Alternative to Phenytoin for Prophylactic Use in Post-Traumatic Seizures: a Literature Review Nagatri, Gabriela; Situmorang, Dicky Arjuna; Ramoti, Natanael; Siahaan, Andre Marolop Pangihutan; Indharty, Rr. Suzy; Tandean, Steven
Jurnal Neuroanestesi Indonesia Vol 13, No 3 (2024)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v13i3.622

Abstract

Traumatic brain injury (TBI) is a common concern for the causes of disability and mortality and it can cause post-traumatic seizure (PTS). Currently, Brain Trauma Foundation (BTF) recommends phenytoin (PHY) as early PTS prophylaxis for patients with severe TBI. The two most common drugs prescribed for PTS are levetiracetam (LEV) and PHY. However, PHY displays a wide array of disadvantages. LEV appears as a better alternative to PHY because of its easier administration, the absence of need for drug level monitoring, lower drug-drug interaction, and better side-effects profile. It is due to the linear elimination kinetics LEV had in comparison to PHY that have zero order pharmacokinetics. Theoretically, LEV is better than PHY. But according to prior studies, LEV and PHY have comparable efficacy at preventing PTS in the early stages. Furthermore, the current evidence is insufficient to definitely recommend LEV over PHY in terms of effectiveness and adverse effects. This study aimed to analyze levetiracetam as an alternative to phenytoin for prophylactic use in post-traumatic seizure.

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