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Jurnal Neuroanestesi Indonesia
Published by Indonesian Society of Neuroanesthesia & Critical Care
ISSN : 20889674     EISSN : 24602302     DOI : https://doi.org/10.24244/jni
Core Subject : Health, Science, Education,
Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health
Editor of the magazine Journal of Neuroanestesi Indonesia receives neuroscientific articles in the form of research reports, case reports, literature review, either clinically or to the biomolecular level, as well as letters to the editor. Manuscript under consideration that may be uploaded is a full text of article which has not been published in other national magazines. The manuscript which has been published in proceedings of scientific meetings is acceptable with written permission from the organizers. Our motto as written in orphanet: www.orpha.net is that medicine in progress, perhaps new knowledge, every patient is unique, perhaps the diagnostic is wrong, so that by reading JNI we will be faced with appropriate knowledge of the above motto. This journal is published every 4 months with 8-10 articles (February, June, October) by Indonesian Society of Neuroanesthesia & Critical Care (INA-SNACC). INA-SNACC is associtation of Neuroanesthesia Consultant Anesthesiology and Critical Care (SpAnKNA) and trainees who are following the NACC education. After becoming a Specialist Anesthesiology (SpAn), a SpAn will take another (two) years for NACC education and training in addition to learning from teachers in Indonesia KNA trainee receive education of teachers/ experts in the field of NACC from Singapore.
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 363 Documents
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Diagnosis and Management of Cerebral Vasospasm Following Aneurysmal SAH Oktavian, Mirza; Bisri, Dewi Yulianti; Rachman, Iwan Abdul
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.v14i3.657

Abstract

Cerebral Vasospasm, characterized by the progressive constriction of cerebral arteries, often occurs following a subarachnoid hemorrhage (SAH) and is a leading cause of morbidity and mortality in affected patients. This condition can be resulted in cerebral ischemia, the severity of which correlates with the degree of vasospasm. The underlying pathophysiology involves the encasement of arteries by blood clots, although the intricate interactions between the hematoma and adjacent structures remain incompletely understood. The delayed onset of vasospasm offers a potential window for preventive interventions. However, recent randomized controlled trials have been discouraging, as they failed to demonstrate any significant improvement in patient outcomes with the use of clazosentan (an endothelin antagonist), simvastatin (a cholesterol-lowering agent), or magnesium sulfate (a vasodilator). Current best practices for managing vasospasm include minimizing ischemia by maintaining adequate blood volume and pressure, administering nimodipine (a calcium channel blocker), and, when necessary, performing balloon angioplasty. Over the past two decades, advancements in the management of vasospasm have significantly reduced associated morbidity and mortality rates. Nevertheless, vasospasm remains a critical determinant of clinical outcomes following aneurysmal rupture.
Multiple Large Cerebral Infactions in Tuberculous Meningitis: A Rare Case Kustila, Ela; Dian, Sofiati
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.v14i3.688

Abstract

Cerebral infarction is well known as a consequence arising from tuberculous meningitis (TBM), which generally involves the small and medium-sized intracranial arteries. These infarcts are usually located in regions termed the “TB zone,” perfused by the medial striate and thalamo-perforating arteries, and in the “ischemic zone,” supplied by the lateral striate, anterior choroidal, and thalamogeniculate arteries. In contrast, the involvement of larger arteries is an uncommon feature of tuberculous vasculitis. We report the case of a 24-year-old man with TBM and pulmonary tuberculosis, without HIV infection, who developed loss of consciousness after undergoing a ventriculoperitoneal (VP) shunt procedure. Neuroimaging with computed tomography (CT) revealed extensive cerebral edema accompanied by massive infarctions involving the cerebellum, cerebral hemispheres, and brainstem. These findings illustrate an unusual presentation of multiple large cerebral infarctions associated with TBM. Such extensive infarcts represent severe complications that can be resulted in profound neurological deficits. This case underscores the importance of early recognition and management of TBM-related complications. Prompt initiation of antituberculosis therapy is essential to reduce the risk of fatal outcomes. Moreover, further investigations are warranted to establish more effective therapeutic approach and optimize patient prognosis
Pediatric Spinal Cord Contusion: A Case Report Highlighting Clinical Symptoms and Management Strategies in a 2-Year-Old Patient Chriswidarma, Dewa Gede; Adityawarma, Anak Agung Ngurah Agung Harawikrama; Lauren, Christopher; Satyarsa, Agung Bagus Sista; Suarjaya, I Putu Pramana; Mahadewa, Tjokorda Gde Bagus
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.v14i3.692

Abstract

Spinal cord injuries (SCI) can be resulted in permanent disability, often caused by high-intensity incidents such as car accidents, falls, and violent crimes. Although relatively rare in children, they can have profound effects. This case report was aimed to elucidate the clinical symptoms of Th1-Th3 spinal contusion in a 2-year-old patient. A 2-year-old boy presented to a private peripheral hospital with complaints of back pain following a traffic accident. The examination revealed complete motor weakness (0/5) in both lower extremities, with preserved sacral sparing. Thoracolumbar MRI demonstrated spinal cord contusion and edema at the level of Th1-Th3. Based on history, physical examination, and supporting tests, the patient was diagnosed with SCI ASIA Impairment Scale B and upper thoracic spinal cord contusion, leading to the decision to perform laminectomy at the Th2-Th3 level. This case underscores the importance of recognizing initial symptoms in spinal cord injury cases and being vigilant for red flags in spinal trauma cases. Prompt initial trauma treatment, such as patient immobilization, is crucial. In this instance, laminectomy decompression was undertaken to address the contusion. A high level of vigilance was required as neurological symptoms could evolve or be initially obscured. Spinal cord injuries often manifest within days of an accident, although they can remain undetected for extended periods. Cord contusions may present with neurological symptoms, necessitating prompt diagnosis via spinal magnetic resonance imaging (MRI) and potential emergency surgical intervention, such as laminectomy.
The Management of Peritumoral Brain Bisri, Dewi Yulianti; Bisri, Tatang
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.v14i3.586

Abstract

Brain edema is classified into four main types: vasogenic, cellular, osmotic, and interstitial. These types may be triggered by various conditions, such as head injuries, vascular ischemia, intracranial lesions, and obstructive hydrocephalus. Several factors are associated with the development of (the swelling of the brain including tumors, physical injuries, insufficient oxygen supply (hypoxia), infections, disruption in metabolism, or acute hypertension. Vasogenic brain edema, the most prevalent form of brain edema, is characterized by a blood- brain barrier (BBB) disorder. When the BBB is compromised, ions and proteins move more easily into the extravascular space, creating an osmotic effect that fluid into the brain’s interstitium. In brain tumors, cerebral edema occurs due to leakage of plasma into the parenchyma caused by impaired function of cerebral capillaries. Management of brain edema focuses on two key strategies: preventing further damage caused by the increased fluid in the brain, and addressing the underlying cause of the edema. Corticosteroids are frequently used as a primary therapy for this condition. While low-dose corticosteroids are preferred to minimize serious adverse effects such as myopathy or diabetes, higher doses of dexamethasone-sometimes along with osmotherapy (e.g. mannitol) or surgical interventions- may be necessary in emergency situations. Careful tapering of corticosteroids is essential to prevent dependence or withdrawal symptoms. New therapies, such as vascular endothelial growth factor receptor inhibitors and corticotropin-releasing factor, require additional clinical evaluation. A thorough understanding of pathophysiology of brain edema is crucial for optimizing the treatment strategies both before and after surgical procedures.
Neuromonitoring on The 3rd Redo Craniotomy for Removal of Infratentorial Tumors Allan, Alma Hepa; Kulsum, Kulsum; Suarjaya, I Putu Pramana; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.744

Abstract

Infratentorial brain tumors such as medulloblastoma have serious neurological implications, particularly in children and adolescents. Re-craniotomy for infratentorial lesions increases the risk of anesthetic complications due to altered anatomy, tissue adhesions, and proximity to vital structures such as the brainstem and cranial nerves. The anesthetic approach must be tailored to support real-time intraoperative monitoring, such as Intraoperative Neurophysiological Monitoring (IONM), to prevent neurological injury. A 16-year-old male with a WHO Grade IV medulloblastoma in the left cerebellum extending to the vermis underwent re-craniotomy tumor removal. The patient presented with balance disturbances, diplopia, and dysphagia. CT scan revealed a solid mass measuring 6.6 × 5.96 × 6.71 cm with peritumoral edema and compression of the fourth ventricle. Anesthetic management included TIVA using propofol TCI Schneider 2–4 mcg/ml, dexmedetomidine 0.2–0.7 mcg/kg/hr, and intermittent rocuronium. The surgery lasted 8 hours and was complicated by cerebral edema managed with mannitol 1 g/kgBW. IONM detected prolonged activation of the left cranial nerve VIII. Intraoperative bleeding reached 1600 ml, managed with 465 ml of PRC. Hemodynamics remained stable with ConnX ranging from 34 to 80. Postoperatively, the patient was admitted to the ICU with mechanical ventilation and continuous sedation. Anesthetic management of infratentorial re-craniotomy requires an individualized approach encompassing hemodynamic stability, neural protection through IONM, and multimodal strategies to prevent postoperative complications. TIVA techniques and ConnX monitoring play an important role in maintaining optimal anesthetic balance and neurological function.
The Use Dexmedetomidine as a Total Intravenous Anesthesia–Propofol Adjuvant for Aneurysm Clipping Sepriwan, Tori; Saleh, Siti Chasnak; Lalenoh, Diana Ch.
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.732

Abstract

Intracranial aneurysm is a cerebrovascular disease with a high mortality rate, particularly in cases of rupture. Aneurysm clipping surgery is one of the definitive management methods; however, it involves significant hemodynamic fluctuations that may lead to intraoperative complications and worsen prognosis. Hemodynamic stability and rapid anesthetic recovery are crucial aspects for the success of this procedure. We report a case of a 57-year-old female with a saccular aneurysm in the right M1 segment of the middle cerebral artery, scheduled for aneurysm clipping surgery. The patient had previously undergone decompressive craniectomy and hematoma evacuation due to non-traumatic intracranial hemorrhage, which was not initially diagnosed as an aneurysm, and showed no significant improvement postoperatively. In anesthetic management, dexmedetomidine was used as an adjuvant to maintain hemodynamic stability and support rapid recovery. Throughout the procedure with TIVA- Propofol, dexmedetomidine effectively maintained stable blood pressure without episodes of hypertension, hypotension, or bradycardia. The patient did not experience significant intraoperative complications, and postoperative recovery was optimal. This emphasizes the critical role of dexmedetomidine within modern anesthetic approaches to the management of intracranial aneurysm cases.
Propofol and Dexmedetomidine potentially maintain BIS, MAP, and BGA in Brain Tumor Patients Ismail, Taufik Suryadi; Kulsum, Kulsum; Khairuddin, Khairuddin; Jamal, Fachrul
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.711

Abstract

Introduction: Brain tumors have a high morbidity and mortality rate in Indonesia. According to data from the Ministry of Health, in 2020 the incidence of brain tumors was around 1.5 percent of all tumor cases. Anesthesia for brain tumor removal surgery has a high risk of postoperative complications such as hypotension, bleeding and intracranial infection. Propofol and dexmedetomidine are often used as anesthetic agents in neurosurgery that affect hemodynamics, depth of anesthesia and blood gas analysis. This study aims to determine the comparative effectiveness of propofol compared to dexmedetomidine on Bispectral Index (BIS), mean arterial pressure (MAP), and blood gas analysis (BGA) in patients undergoing intracranial tumor removal surgery.Subject and Method: This study is an unpaired numerical comparative analytical observational study. A total of 42 participants who met the inclusion and exclusion criteria were randomly assigned into 2 groups, namely the propofol and dexmedetomidine groups. Furthermore, an assessment of mean arterial pressure, BIS, and BGA was carried out.Results: Based on statistical tests using the unpaired T test, it was found that intraoperative MAP was significantly different between the two groups (p0.05), where dexmedetomidine had a more stable MAP. While in BIS and BGA there was no significant difference in the two groups (p0.05) statistically using the Mann Whitney test.Conclusion: Dexmedetomidine has an effect that is not much different compared to propofol in maintaining changes in MAP, BIS and BGA in patients with intracranial tumor removal surgery. 
Anesthetic Management in Patient with Traumatic Brain Injury undergoing Elective Spinal Surgery Soedibjo, Dennis Prakas; Harahap, Mohamad Sofyan; Gaus, Syafruddin
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.728

Abstract

The incidence of traumatic brain injury that concurrent with injuries such us traumatic spinal injuries is relatively high. When considering anesthetic management for patients with acute traumatic brain injury undergoing non-brain surgery procedures, understanding of the implications of traumatic brain injury on anesthesia management is essential for achieving favorable surgical results while minimizing the risk of secondary brain injury to ensure patient safety and optimal outcomes. We report a case of a 25 years old man who presented with decrease of consciousness 3 days prior admission to the hospital after sudden fall in the bathroom. Complaints were accompanied with vomiting, weakness and paresthesia in both bilateral upper extremities and lower extremities. Supportive examination revealed an epidural hematoma at regio frontoparietal sinistra, minimal subdural hematomas at regio anterior falx cerebelli and bilateral tentorium cerebelli, subgaleae hematomas at regio bilateral parietal, with multiple cervical fracture at the C5 level with associated cervical canal narrowing. Due to the minor intracranial bleeding with no significant symptoms for days, patient then scheduled for elective C4-C6 laminectomy and posterior stabilization surgery. Anesthesia management for patient with traumatic brain injury that undergoes non-brain surgery comes with challenges, mainly on how to prevent secondary brain injury and minimizing complications. Comprehensive perioperative planning and vigilant monitoring are essential to ensure patient safety and optimal outcomes
Cerebral Perfusion Pressure in Traumatic Brain Injury: A Dynamic Battlefield of Flow and Pressure Primanov, Rama Mahardika; Putri Maharani, Dinda; Maria Situmorang, Ruth; Indharty, R. R. Suzy; Marolop Pangihutan, Andre
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.668

Abstract

Introduction: Traumatic brain injury (TBI) affects 27-69 million people annually, with over 55 million living with long-term disability. A major management challenge is disruption of cerebral autoregulation, a mechanism that maintains stable cerebral blood flow (CBF) despite systemic pressure changes. Impaired cerebral perfusion pressure (CPP) autoregulation promotes ischemia, edema, and metabolic imbalance, worsening neurological outcomes. Method: This narrative review synthesized literature from PubMed, Google Scholar, ScienceDirect, and the Cochrane Library, focusing on studies from the past decade. Keywords included “cerebral perfusion pressure,” “autoregulation,” “traumatic brain injury,” “TBI,” “mechanism,” “pressure reactivity index,” and “monitoring.” Discussion: TBI-related autoregulation impairment stems from vascular injury, inflammation, and myogenic dysfunction, with patterns ranging from intact to delayed or absent responses. The pressure reactivity index (PRx) enables continuous autoregulation assessment and determination of patient-specific optimal CPP (CPPopt). Observational data link maintaining CPP near CPPopt with better outcomes, while time below CPPopt increases mortality risk. Experimental models identify endothelin-1, ERK1/2, and interleukin-6 as key mediators, with targeted interventions showing potential to preserve reactivity. Conclusion: Integrating mechanistic insights with invasive monitoring and PRx-guided CPP optimization offers a promising, individualized strategy for TBI care, warranting confirmation in large clinical trials.
Ultrasound-Guided Scalp Block as an Anesthetic Technique and Postoperative Analgesia for Awake Cranioplasty in High-Risk Patients Luailiyah, Afridatul; Prihatno, M. Mukhlis Rudi; Wicaksono, Nugroho
Jurnal Neuroanestesi Indonesia Vol 15, No 1 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i1.729

Abstract

Cranioplasty is a surgical procedure that restores normal anatomy following craniectomy. Skull bone reconstruction ensures protection and normalizes physiology as well as cerebrospinal fluid dynamics. We present a case of a 37-year-old male following intracerebral hemorrhage (ICH) evacuation via craniotomy. The patient had uncontrolled hypertension and cardiomegaly on chest X-ray, with secondary hemiparesis. Scalp nerve block was employed as an anesthetic technique and for postoperative analgesia. Preoperatively, his heart rate was 70–80 beats/min, blood pressure 158/107 mmHg, and oxygen saturation 100% on room air. Intravenous dexmedetomidine infusion was started (loading dose 1 mcg/kg for 15 minutes, followed by 0.4–0.8 mcg/kg/h) along with 2% lidocaine infusion at 1 mg/kg/h titrated to the desired level of sedation and analgesia. A unilateral (landmark-guided) scalp block was performed using 22 mL of 0.5% levobupivacaine to block the supraorbital, supratrochlear, zygomaticotemporal, auriculotemporal, greater occipital, and lesser occipital nerves. The patient also received intravenous paracetamol 1 g three times daily. Hemodynamics remained stable throughout surgery. The Numeric Rating Scale (NRS) score was 0 at 30 minutes to 6 hours postoperatively, and 1–2 between 8 and 48 hours. Awake regional anesthesia allowed sympathetic tone to remain intact and enabled rapid postoperative neurological assessment. Ultrasound-guided scalp block is an effective alternative anesthetic technique for awake cranioplasty, providing hemodynamic stability, optimal pain control, and faster recovery in high-risk patients

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