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Agni Susanti
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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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Opioid-Free Anesthesia Technique for Anterior Cervical Discectomy and Fusion (ACDF): Anesthesia Management Cobis, Albinus Yunus; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.660

Abstract

Anterior cervical discectomy and fusion (ACDF) is a safe and effective surgical procedure to treat cervical spine pathology. ACDF treats Cervical Spondylotic Myelopathy (CSM), where degeneration of the cervical vertebrae compresses the spinal cord, causing sensory, motor, reflex, and bowel function impairment. The use of opioids can have unpleasant effects, hence opioid-free anaesthesia techniques were developed as a strategy to reduce this risk. A man, 62 years old, complained of weakness in the upper limbs until it was difficult to move the hands. Supportive examination revealed cervical myeloradiculopathy due to multiple hernia nucleus pulposus (HNP). Management of opioid-free anaesthesia techniques using multimodal analgesics. During the operation, haemodynamics were relatively stable. Extubation was performed in the operating room and then the patient was transferred to the intensive care unit. The choice of opioid-free anaesthesia technique in the case was to provide multimodal using specific agents that have anaesthetic or analgesic properties. Opioid-free anaesthesia methods that support the Enhanced Recovery after Surgery (ERAS) concept are considered highly beneficial in accelerating recovery time, reducing length and cost of treatment and minimizing opioid-related unpleasant risks. The opioid-free anaesthetic technique in this case report demonstrates the feasibility and benefits of opioid-free anaesthesia in effective pain management and minimizing opioid-related risks, especially in ACDF surgical procedures. This technique is in line with the ERAS protocol.
Dexmedetomidine as an Adjunct in Anesthesia for Adolescent Idiopathic Scoliosis (AIS) Surgery: A Case Series Nofiyanto, Eko; Halimi, Radian Ahmad; Fuadi, Iwan; Abdul rachman, Iwan
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.682

Abstract

Scoliosis is a spinal curvature deformity 10, with Adolescent Idiopathic Scoliosis (AIS) affecting those aged 10-18 years. The global prevalence of AIS is between 1%-2%, while in Indonesia, it stands at 2,93%, with a female-to-male ratio of 4.7:1. Perioperative challenges include nerve damage, bleeding, and postoperative pain. Neuromonitoring (MEP and SSEP) helps prevent injury, while careful drug selection supports spinal protection. Three female patients scoliosis reconstructions were performed under general anesthesia. All received target- controlled infusion (TCI) propofol, dexmedetomidine, and fentanyl, with stable hemodynamics and no neurological changes post-surgery. Epidemiological data showed that AIS predominantly affects females. The study included patients with curve progression impacting activity, with no motor or sensory abnormalities observed. Anesthesia was induced with propofol TCI (4 ?g/mL) and dexmedetomidine (0.3-0.7 mcg/kg/hr), reducing propofol and opioid use. Dexmedetomidine targets ?2-adrenergic receptors, reducing sympathetic outflow, stabilizing hemodynamics, blocking pain transmission, and improving recovery by reducing blood loss and inflammation. Dexmedetomidine provides sedation, analgesia, and stable hemodynamics in scoliosis surgery, minimizing blood loss and transfusion needs. It supports neurophysiological monitoring, reduces postoperative pain, and enhances recovery.
A Rare Case of Rapidly Progressing Vertex Epidural Hematoma in A Child: Diagnostic Pitfalls and Management Considerations Bangun, Kristian Gerry Raymond Sinarta; Satyarsa, Agung Bagus Sista; Niryana, Wayan
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.661

Abstract

Vertex Epidural Hematoma (EDH) is a rare condition, often caused by injury to the superior sagittal sinus or parietal bone fractures, typically involving diploic veins. It can be associated with sudden death. This case highlights a rapidly progressing vertex EDH in a child within 12 hours, despite initial mild symptoms. A 10-year-old boy sustained a head injury and experienced a 10-minute loss of consciousness. Upon arrival at Ngoerah General Hospital, his Glasgow Coma Scale (GCS) score was E4V5M6, and a head CT showed a small vertex EDH. Conservative management was started. Twelve hours later, the child reported worsening headaches and drowsiness, and his GCS decreased to E3V5M6. A repeat CT scan revealed significant hematoma expansion, prompting emergency surgery. During surgery, a linear fracture of the parietal bone was found, with approximately 60cc of hematoma due to diploic vein rupture. Post-surgery, the patients GCS improved without neurological deficits. As conclusion the Vertex EDH in children, though rare, demands careful monitoring. This case underscores the importance of early reevaluation, prompt imaging, and timely surgical intervention to avoid irreversible neurological damage
Pressure Reactivity Index (PRx): A Concept to Optimize Cerebral Perfusion Pressure in Traumatic Brain Injury Uhud, Akhyar Nur; Bisri, Dewi Yulianti; Jasa, Zafrullah Khany; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.693

Abstract

Two common factors contributing to poorer outcomes in TBI patients are high intracranial pressure (ICP) and low cerebral perfusion pressure (CPP). These two factors constitute a vicious circle that will have a negative impact on TBI patients. An increase in ICP will cause a decrease in CPP, while a reduction in CPP will cause ischemia, which will worsen the high ICP. However, increasing the CPP by increasing MAP will not help the situation; in fact, it may worsen the impact due to impairment of cerebral autoregulation (CA). Therefore, it is critical to manage TBI patients with an ideal CPP. Pressure reactivity index (PRx) is a measurement of the linear relationship between the mean arterial pressure (MAP) and ICP. A positive correlation between ICP and MAP indicates an impairment of CA, which suggests a suboptimal CPP value. The basis of PRx theory is that the rise, because of the presence of CA, an increase in MAP should not be followed by the rise in ICP because there is a compensatory effect in the form of a decrease in cerebral blood volume, so that ICP does not increase. That being said, this mechanism will not work when the limit of autoregulation is exceeded. Based on PRx and CPP, an optimal CPP could be obtained by using a U-shaped curve. The outcomes of TBI patients can be enhanced by treating them according to their optimal CPP (CPPopt).
The High-Stakes Balance: Patient Safety and Neurosurgical Practice in a COVID-19 Pandemic Sumardi, Fitri Sepviyanti
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.616

Abstract

Introduction: The COVID-19 pandemic profoundly affected neurosurgical practices globally, prompting the introduction of emergency health protocols to safeguard patients and healthcare personnel. While these measures were essential for controlling virus spread, they were resulted in challenges like surgical delays, resource shortages, and heightened stress for medical staff. This study aims to evaluate the impact of these protocols on neurosurgical care, identify the challenges posed, and suggest strategies to enhance patient safety and healthcare resilience in future outbreaksSubject and Methods: This qualitative study involved a systematic literature review on PubMed, Google Scholar, and ScienceDirect, along with interviews with neurosurgeons, anesthesiologists, and intensive care specialists. Through thematic analysis, it explored the disruptions in neurosurgical care during the pandemic, the adaptive strategies employed, and their impact on patient outcomes and medical staff well-being.Results: The study found that while emergency health protocols helped minimize COVID-19 transmission, they caused significant disruptions in neurosurgical care, with 30% of patients experiencing delays that adversely affected their outcomes. PPE shortages, inconsistent preoperative screening, and changing health protocols complicated surgical workflows. Hospitals with structured triage systems, expanded telemedicine, and enhanced preoperative screening managed the crisis better. Additionally, healthcare workers' psychological distress was reduced through improved mental health support and resource availability.Conclusion: The COVID-19 pandemic has transformed neurosurgical practice, highlighting the need for adaptation and resilience in healthcare. Strengthening collaboration, optimizing resources, and integrating technology will better prepare neurosurgical teams for future public health emergencies while maintaining high-quality patient care.
Anesthesia Considerations in Patients with Heart Failure who will Undergo Glioblastoma Tumor Removal Surgery Suranadi, I Wayan; Adistaya, Anak Agung Gde Agung; Jeanne, Bianca
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.653

Abstract

Perioperative complications in neurosurgery encompass a range of issues, including hemodynamic instability, significant bleeding, extended procedure durations, and unusual patient positioning. Additionally, fluctuations in carbon dioxide levels, whether hypercapnia or hypocapnia, can contribute to secondary brain injury. Hemodynamic instability is particularly likely during critical moments such as laryngoscopy and intubation, head pins, and the manipulation of the scalp, bone, and dura mater. Patients with congestive heart failure (CHF) and other cardiovascular comorbidities require special attention throughout the entire surgical process, from the preoperative period through to postoperative care. Here, we present a case study on the successful anesthesia management of a patient with moderate heart failure undergoing glioblastoma tumor removal surgery. This case underscores the necessity of individualized anesthetic approaches and vigilant monitoring to minimize risks and ensure patient safety in complex neurosurgical procedures. The main goal of anesthesia in CHF patient undergo neurosurgical procedure are to maintain cerebral perfusion pressure, decrease Intracranial Pressure, Cardiovascular monitoring, maintain hemodynamic stability using vasopressor, inotrope, and fluid balance, and special consideration of position and long surgical time. By carefully managing these perioperative challenges, we can improve outcomes for patients with significant comorbidities undergoing high-risk surgeries.
Therapeutic Potential of Cilostazol in Aneurysmal Subarachnoid Hemorrhage: A Systematic Review Felicia, Felicia; Jaya, Michael
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.613

Abstract

Introduction: Vasospasm and delayed cerebral infarction (DCI) are factors that influence the prognosis and clinical outcomes in subarachnoid hemorrhage (SAH). Although several pharmacological therapies are considered potentially effective in reducing vasospasm and DCI, only a few have shown significant benefits. This systematic review aims to evaluate the therapeutic benefits of cilostazol in patients with aneurysmal subarachnoid hemorrhage (aSAH). Subject and Methods: A systematic search was conducted on studies from January 2009 to March 2024 across five databases, guided by PRISMA 2021. The outcomes evaluated may include angiographic vasospasm, symptomatic vasospasm, the severity of vasospasm, new cerebral infarctions, delayed cerebral ischemia, and functional outcomes. Results: Following analysis, 9 studies were included in this systematic review, involving 627 patients in the cilostazol group and 631 patients in the control group. Most of these studies indicated that cilostazol administration in SAH yielded positive effects on cerebral vasospasm, new infarctions, and functional outcomes. However, there was no evidence to support the effectiveness of cilostazol in preventing DCI. Conclusion: Overall, cilostazol appears to be a promising therapy for SAH. However, the impact of cilostazol on DCI warrants further investigation, possibly due to the complex mechanisms of DCI.
Adverse Event : Myocardial Injury after Non-Cardiac Surgery (MINS) Post Craniectomy in Critical Care Fajri, Doni; Anggraeni, Novita; Hidayat, Nopian; Ananda, Pratama
Jurnal Neuroanestesi Indonesia Vol 14, No 2 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i2.664

Abstract

Intracerebral hemorrhage (ICH) describes the non-traumatic parenchymal hemorrhage caused by the rupture of cerebral vessels, accounting for 2030% of all strokes. ICH will cause compression on the surrounding brain tissues, eventually giving rise to increased intracranial pressure. Decompressive craniectomy (DC) effectively reduce intracranial pressure. Myocardial injury is defined as an elevation of cardiac troponin levels with or without associated ischemic symptoms. Case a male, 66 years old patient was admitted to the ICU after undergoing Emergency Craniectomy Hematoma Evacuation due to Spontaneous ICH. After 52 hours of treatment, the patient was found to have ventricular tachycardia (VT) on the monitor and restlessness. The patient was also found to have comorbid hypertension. On a 12-Lead ECG we found NSTEMI, and Troponin I level was measured at 453.0 ng/L (positive). This patient was treated with anticoagulants, antiplatelet and statin, with monitoring of the ECG daily. On The 6th day patient was moved to High Care Unit (HCU). Myocardial Injury after Noncardiac Surgery is defined by elevated postoperative cardiac troponin concentrations, with or without accompanying symptoms or signs. It typically occurs within 30 days after surgery. The management of MINS involves the use of anticoagulants and antiplatelet therapy. Anticoagulant therapy should be considered between benefit and risk of re-bleeding post operative. MINS is a rare condition but is associated with an increased risk of 30-day mortality. A multidisciplinary treatment approach and a coordinated team effort are essential for improving the outcomes of patients with this condition.
Effect of Centella Asiatica (L.) Extract on Serum Levels of IL-6 and IL-10 in Traumatic Brain Injury Rat Nurafia, Sindy; Prihatno, MM Rudi; Novrial, Dody; Nafiisah, Nafiisah
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.611

Abstract

Introduction: Traumatic brain injury (TBI) represents a major global health burden, because it is the foremost causes of death, particularly in young adults. Elevated IL-6 and IL-10 serum levels in severe TBI have been identified as an early indicator of unfavorable clinical outcomes. Pegagan (Centella asiatica (L.)) has antioxidant, neuroprotective, neurogenerative, anti-inflammatory properties. Our goal of this study was to find out what happened to IL-6 and IL-10 levels in blood of the TBI rat model when they were given pegagan extract (Centella asiatica (L.)). Subject and Method: experimental research design. For 3 days, there were 4 groups of male Wistar strain rats (Rattus norvegicus) subjects, consisting of three treatment groups (pegagan extract doses of 300 mg/kgBW, 500 mg/kgBW, and 1000 mg/kgBW) and one control group. On the 4th day, blood was taken, and we continued to examine IL-6 and IL-10 serum levels by ELISA. Result: A dose-dependent and significant increase of IL-6 and IL-10 serum levels was observed in the treatment groups compared with control group. Conclusion: In TBI rat model, administration of pegagan (Centella asiatica (L.)) extract increases IL-6 and IL-10 levels.
Anesthetic Management of Mechanical Thrombectomy for Acute Ischemic Stroke with Severe Mitral Stenosis: A Case Report MD, Burhan; Suarjaya, I Putu Pramana; Ratu, Tiffani; Wiryawan, I Nyoman; MD, Patricia; Tini, Kumara
Jurnal Neuroanestesi Indonesia Vol 14, No 3 (2025)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v14i3.719

Abstract

Acute ischemic stroke from large vessel occlusion requires prompt reperfusion to preserve brain function. Mechanical thrombectomy is the treatment of choice in selected cases, especially cardioembolic strokes. Anesthetic management plays a critical role, particularly in patients with cardiac comorbidities. We report a 62-year-old woman presenting with left-sided weakness and reduced consciousness, six hours prior to admission. She had a history of rheumatic mitral stenosis and atrial fibrillation. CT angiography showed infarction in the right MCA territory with distal ICA occlusion. Intravenous thrombolysis was initiated but failed to show improvement. Mechanical thrombectomy was then performed under general anesthesia. Due to the patient’s decreased consciousness and aspiration risk, general anesthesia was preferred to secure the airway and allow precise hemodynamic control. The anesthetic strategy focused on maintaining systemic vascular resistance while avoiding increased pulmonary vascular resistance to prevent right heart overload in mitral stenosis, also oxygenation and ventilation were carefully managed to avoid hypoxia and hypercapnia. Full vessel recanalization (mTICI 3) was achieved without complication. This case highlights the importance of tailoring anesthesia to individual risk profiles, particularly in stroke patients with valvular heart disease, where general anesthesia may provide optimal safety and procedural success.

Page 35 of 36 | Total Record : 354

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