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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 371 Documents
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Predictors of Neurosurgical Outcomes in Traumatic Brain Injury: A Study from Banda Aceh, Indonesia Niazie, Azzie; Jasa, Zafrullah Khany; Rahmi, Rahmi; Yusmalinda, Yusmalinda
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.v15i1.750

Abstract

Introduction: Traumatic brain injury (TBI) remains a major global health challenge and frequently requires neurosurgical intervention. Various clinical, surgical, and systemic factors may influence postoperative morbidity and mortality. This study aimed to identify key predictors of postoperative outcomes in patients with TBI undergoing neurosurgical procedures.Subject and Method: A prospective cohort study was conducted at Dr. Zainoel Abidin General Hospital in Banda Aceh from July to October 2024, involving 48 TBI patients who were selected through total sampling. Statistical analysis using chi-square tests and multiple logistic regression identified significant predictors.Results: We enrolled 48 patients, with an overall postoperative morbidity rate at 58.3%, and the mortality rate was 22.9%. Morbidity was significantly associated with preoperative GCS score (p=0.001), injury-to-surgery time (p=0.039), respiratory (p=0.007), and cardiovascular system (p=0.001). Mortality was significantly associated with preoperative GCS score (p=0.002), surgery duration (p=0.041), respiratory (p=0.041), and cardiovascular system (p=0.004). Multivariate analysis confirmed the preoperative GCS score was the most significant predictor of both morbidity and mortality (p0.05).Conclusion: A low preoperative GCS score is a strong predictor of poor postoperative outcomes in patients with TBI. Optimizing perioperative management may improve clinical outcomes in TBI patients undergoing neurosurgical intervention
Basic Principles of Processed Electroencephalography for Neuroanesthesiologists Pramodana, Bintang; Fuadi, Iwan
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.v15i1.743

Abstract

Processed electroencephalography (pEEG) has become an integral tool in modern anesthesia and critical care, enhancing the precision of anesthesia depth monitoring, reducing the risk of accidental awareness under general anesthesia (AAGA), and postoperative cognitive issues. Unlike raw EEG, which records cortical electrical activity directly, pEEG applies mathematical and algorithmic analyses, such as spectral analysis and Fourier transformation, to generate numerical indices that are more interpretable for clinicians. Several commercial systems, including the Bispectral Index (BIS), Entropy, Conox, and SedLine, are widely available. For neuroanesthesiologists, understanding core EEG principles and advanced metrics, such as the Density Spectral Array (DSA), Spectral Edge Frequency (SEF), and Burst Suppression Ratio (BSR), is crucial for accurate interpretation. Moreover, recognizing EEG patterns characteristic of various anesthetic agents, including propofol, inhaled agents, dexmedetomidine, ketamine, and opioids, further refines clinical decision-making. Mastery of EEG interpretation ultimately supports better safety, individualized neuroanesthesia practice aligned with the principles of precision medicine
Mini-Craniectomy for Traumatic for Posterior Fossa Acute Liquid Epidural Hematomas in Paediatric Patient: A Case Report Permana, Padma; Satyarsa, Agung Bagus Sista; Wardhana, Dewa Putu Wisnu
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.v14i3.697

Abstract

Posterior fossa epidural hematoma (PFEDH) is a rare condition, accounting for only 0.1-0.3% of all traumatic brain injuries. Patients can rapidly deteriorate due to brainstem compression caused by bleeding in the posterior cranial fossa. Timely surgical intervention is critical, but currently, there is no consensus on the surgical indication and technical approach for pediatric PFEDH. Case Presentation: A five-year-old boy presented with occipital trauma, headache, vomiting, and altered consciousness after a fall from a 1-meter height. Primary survey was clear with a Glasgow Coma Scale (GCS) score of E3M6V4 and slow pupillary reflexes while secondary examination revealed a 1x2 cm cephalhematoma over the right posterior fossa region. Head CT scan revealed a posterior fossa liquid epidural hematoma measuring 5.4 x 2.2 x 4cm with cerebellar displacement. The patient underwent a mini-craniectomy and recovered with a relatively short operative duration, minimal blood loss, and a short hospital stay without neurological deficits. Mini-craniectomy emerges as a viable and promising alternative procedure in the management of carefully selected pediatric PFEDH cases, particularly those that are liquid or of moderate volume, allowing for efficient evacuation with minimal surgical morbidity with a good prognostic outcome
General Anesthesia and Scalp Block for Craniotomy Due to Cerebral Abscess in Uncorrected Tetralogy of Fallot Patient: A Case Report and Literature Review Zafrullah Khany Jasa; Hermasnyah Hermasnyah; Muhammad Iqbal
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.733

Abstract

Introduction: Neurosurgery in Tetralogy of Fallot (ToF) poses complex anesthetic challenges due to risks of hypoxemia and hemodynamic instability. The aim of this case report was to describe the general anesthesia and scalp block management of a boy with uncorrected ToF who developed a cerebral abscess requiring craniotomy for abscess drainage. Case: An 8-year-old boy with uncorrected ToF presented with headache, fever, and neurological deficits. Neuroimaging revealed a large frontal abscess necessitating urgent surgical intervention. Preoperative evaluation showed central cyanosis, digital clubbing, and oxygen saturation of 70% on room air, with echocardiography demonstrating a significant right-to-left shunt. The primary anesthetic objectives were to maintain systemic vascular resistance (SVR) and prevent increases in pulmonary vascular resistance (PVR). Anesthesia induction was achieved with ketamine 1 mg/kg and fentanyl 4 µg/kg to preserve SVR, followed by rocuronium 0.5 mg/kg for neuromuscular relaxation. A bilateral scalp block was administered with ropivacaine 0.25% (0.4 mL/kg per site) for regional analgesia. The surgery was completed without complications, and the patient was extubated safely after 24 hours in the pediatric intensive care unit. Discussion: Anesthetic management of uncorrected ToF during neurosurgery focuses on maintaining SVR and avoiding increases in PVR to prevent worsening right-to-left shunting and hypoxemia. Ketamine-based induction and bilateral scalp block provided hemodynamic stability and effective analgesia, facilitating successful surgical and postoperative outcomes without major complicationsConclusion: Individualized anesthetic management that prioritizes SVR preservation, PVR control, and meticulous hemodynamic monitoring is essential for safe neurosurgical procedures in uncorrected ToF.
In-Hospital Complications are Associated with Prolonged Length of Stay in Acute Ischemic Stroke Patients Lisda Amalia
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.767

Abstract

Background and Objective: Stroke is an economic and health burden for patients, society, and health services; and one is the length of stay hospitalization. Ischemic stroke patients with hospitalization 7 days indicate the quality of hospital stroke services. This study aimed to compare the clinical characteristics of ischemic stroke patients during hospitalization at Dr. Hasan Sadikin Hospital Bandung, Indonesia.Subject and Method: This study was cross-sectional, with a sample research subjects of all ischemic stroke patients from January to April 2023 at Dr. Hasan Sadikin General Hospital Bandung, Indonesia were divided into 2 groups, namely the ≤ 7 days and the 7 days group. The indicators characteristics were age, onset, National Institute of Health of Stroke Scale (NIHSS), Neutrophyl-to-Lymphocyte Ratio (NLR), and complications obtained through medical records. Statistical analysis was calculated using the Mann-Whitney and Fisher correlation tests.Results: A total of 59 subjects, there are no significance difference (p0.05) on variables of age (median 58 vs 63 years), onset (median 11 vs 7 hours), NIHSS (median 6 vs 8), and NLR (median 3.22 vs 4.41). In-hospital complications such as infection and hyponatremia, was significantly different between two groups (p0.05). Conclusion: In-hospital complications are associated with prolonged length of stay in patients with acute ischemic stroke. This can be the basis for developing strategies to increase the indicators management of stroke services by reducing the complication ischemic stroke during hospitalization.
TCI of Propofol Combined with Multimodal Analgesia for Neurophysiological Intraoperative Monitoring during Craniotomy for Meckel's Cave Meningioma Resection Ella Priliandini; Buyung Hartiyo Laksono; Eko Nofiyanto; Dewi Arum Sawitri
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.745

Abstract

Introduction: Meckel’s cave meningioma is an intracranial tumor located in close proximity to critical neurovascular structures. An effective anesthetic strategy is essential to optimize outcomes and minimize complications.Case: A 38-year-old woman with progressive ptosis, diplopia, and proptosis was diagnosed with Meckel’s cave meningioma. She underwent craniotomy with intraoperative neurophysiological monitoring (IOM) under general anesthesia managed with Target-Controlled Infusion (TCI) of propofol and dexmedetomidine. TCI of propofol, with Schnider mode was adjusted to a target effect concentration of 2-6 μg/mL. Dexmedetomidine was administered at a dose of 0.3-0.7 mcg/kg/hour. A multimodal analgesic approach, including scalp block with ropivacaine and dexamethasone was performed to reduce opioid consumption and manage pain. The procedure was completed without complications. Postoperatively, the patient demonstrated stable hemodynamics, no new neurologic deficits, and effective pain control.Discussion: Anesthesia protocol, including propofol TCI and dexmedetomidine, was performed to maintain signal integrity, allowing safe tumor resection while minimizing the risk of postoperative deficits. The combination of propofol TCI, dexmedetomidine, and multimodal analgesia was shown to achieve stable hemodynamic and neurophysiological conditions during craniotomy for Meckel’s cave meningioma.Conclusion: The combination of propofol TCI, dexmedetomidine, and multimodal analgesia is effective in maintaining stable hemodynamic and neurophysiological conditions during craniotomy for Meckel’s cave meningioma.
Comparison of the Values of Inflammatory Parameters C-Reactive Protein, Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio between Scalp Block Ropivacaine 0.5% and Intravenous Dexmedetomidine in Craniotomy Brain Tumors Muhamad Soleh; Rr Sinta Irina; Ester L.R. Silaen Silaen; Arlinda Sari Wahyuni
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.645

Abstract

Background and Objective: Craniotomy surgery can increase the body's inflammatory response through the neuroendocrine system. neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) are biomarkers of inflammation and immunosuppression. Scalp block using ropivacaine and intravenous dexmedetomidine are commonly used analgesic techniques to attenuate perioperative inflammatory responses. This study aims to determine the comparison of inflammatory marker values between ropivacaine 0.5% scalp block and intravenous dexmedetomidine in brain tumor craniotomySubject and Methods: This study used a single-blind clinical trial with a two-group posttest-only design. This study collected 36 research subjects who met the inclusion criteria. The subjects were divided into 2 groups, Group A received 0.5% ropivacaine scalp block and Group B received intravenous. Blood tests to assess inflammatory: markers were performed before and 24 hours postoperatively. The data obtained were analysed using SPSS version 20.Results: The change value of CRP in the scalp block ropivacaine 0.5% group was 24.71± 7.25 mg/l, while the change value of CRP in the dexmedetomidine group was 61.02 ± 17.81mg /l. The change value of PLR in the scalp block ropivacaine 0.5% group was 50.57 ± 57.91 while the change value of PLR in the dexmedetomidine group was 105.26 ± 64.81. There was a significant change of CRP and PLR values in the scalp block group compared to the dexmedetomidine group (p0.05). The change value of NLR in the scalp block group was 9.71 ± 5.75, while the change value of NLR in the demedetomidine group was 13.37 ± 5.55. There was no significant difference in the change value of NLR in the ropivacaine 0.5% scalp block group compared to dexmedetomidine (p0.05).Conclusion: Scalp block ropivacaine 0.5% has better results than intravenous dexmedetomidine administration in suppressing the inflammatory response in patients undergoing tumour craniotomy surgery.
Neuroanesthesia in Neurosurgical Emergencies: What Anesthesiologists Ought to Know Ferry Valentino; Riyadh Firdaus; Tesha Monika; Radea Renoza
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.752

Abstract

Neurosurgical emergencies demand rapid and coordinated anesthetic management to prevent secondary neurological injury and improve patient outcomes. Anesthesiologists play a critical role not only in facilitating surgical intervention but also in maintaining cerebral perfusion pressure (CPP), controlling intracranial pressure (ICP), and safeguarding neural function during periods of physiological instability. This review synthesizes current guidelines regarding anesthetic selection, hemodynamic targets, and specific neuroprotective strategies. Furthermore, optimal anesthetic management for acute ischemic stroke is re-evaluated based on recent research suggesting that conscious sedation may offer superior functional outcomes in minor anterior circulation strokes, whereas general anesthesia remains non-inferior for posterior circulation strokes. The review also highlights critical physiologic targets, emphasizing the strict avoidance of hypotension and the judicious use of moderate hypocapnia. By integrating these emerging evidence-based protocols, anesthesiologists can optimize management in neurosurgical emergencies settings, thereby improving patients’ functional recovery and survival rates.
Effects of TCI Propofol on Maternal and Fetal Outcomes in VP-Shunt Surgery during the First Trimester of Pregnancy: A Narrative Review Albinus Yunus Cobis; Iwan Abdul Rachman; Dewi Yulianti Bisri
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.701

Abstract

Neurosurgical procedures during pregnancy, particularly ventriculoperitoneal (VP) shunt placement in the first trimester, pose substantive challenges for anesthetic practice. Drug selection must protect both mother and fetus while accommodating pregnancy-related alterations in pharmacokinetics and pharmacodynamics. Propofol administered via Target Controlled Infusion (TCI) has become a preferred option in neuroanesthesia because it enables rapid reduction in intracranial pressure and precise titration. Reports from neuro-obstetric practice, including VP shunt operations, indicate that TCI propofol maintains stable anesthetic depth with fewer hemodynamic fluctuations than inhalational techniques. In pregnant patients, dosing is individualized using the Marsh model, typically targeting a plasma concentration of 2–4 µg/mL with an induction dose of 1–2 mg/kg. Although propofol readily crosses the placenta, contemporary data show fetal concentrations remain low and are rapidly cleared. Moreover, recent studies have not associated appropriately dosed, closely monitored propofol with increased rates of miscarriage, major congenital anomalies, or reduced live births. Accordingly, for first-trimester neuroanesthesia, TCI propofol is a safe and effective choice that supports maternal cerebral protection while minimizing fetal exposure. When combined with vigilant physiologic monitoring, titration to effect, and adherence to neuro-obstetric best practices, maternal and fetal outcomes are comparable to those achieved with inhalational anesthesia. These findings support the judicious adoption of TCI propofol for VP shunt surgery in early pregnancy, emphasizing individualized dosing and multidisciplinary perioperative coordination to optimize safety and efficacy. This review synthesizes current evidence and offers pragmatic dosing guidance for clinicians, aligned with contemporary neuroanesthesia and obstetric anesthesia standards
Spinal Cord Protection during Stabilization of Severe Thoraco–Lumbal Scoliosis with 90 Degree Cobb Angle Dewi Yulianti Bisri; Kevin Oktavianus Habakuk; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 15, No 2 (2026)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v15i2.747

Abstract

Introduction: Scoliosis correction surgery requires careful anesthetic management because of potential perioperative complications, including excessive bleeding, hypothermia, complications related to patient positioning, and the need for spinal cord protection. Case: A 23-year-old woman weighing 32 kg with a height of 140 cm presented with a chief complaint of spinal deformity that had been present since childhood. On physical examination, her blood pressure was 119/79 mmHg, pulse rate was 112 beats/minute, respiratory rate was 20 breaths/minute, and SpO2 was 97% on room air and a Cobb angle of 90°. Anesthesia induction using propofol 70 mg, while tracheal intubation was facilitated with atracurium 0.5 mg/kg. Analgesia with fentanyl 2 µg/kg, and anesthesia with O2/air, sevoflurane, and atracurium infusion at 0.5 mg/kg/hour. Intravenous tranexamic acid 500 mg to minimize intraoperative bleeding. Intraoperative monitoring consisted of standard monitoring modalities, without the use of spinal cord monitoring. The surgical procedure lasted 4 hours and 20 minutes, with the patient positioned prone throughout the operation. Discussion: The most important principle of anesthetic management in spinal surgery is a comprehensive and meticulous approach to patient positioning, ensuring safe alignment while maintaining adequate spinal cord perfusion pressure. Spinal cord protection was provided with methylprednisolone, hemodynamic stable, normothermia, good patient position.Conclusion: Spinal cord protection did with avoid excessive bleeding, hypothermia, complications related to patient positioning, and maintaining adequate spinal cord perfusion pressure. 

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