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Jurnal Neuroanestesi Indonesia

jni
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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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Gangguan Tidur pada Pasien Stroke Fase Akut Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Stroke adalah suatu kondisi ketika seseorang terkena defisit neurologis secara tiba-tiba yang disebabkan oleh adanya gangguan pada pembuluh darah otak. Sekitar 2177% dari pasien stroke memiliki gangguan tidur yang terjadi setelah stroke. Siklus tidur diatur oleh otak dan stroke dapat menyebabkan gangguan tidur karena kelainan yang dapat terjadi pada struktur otak yang mengatur tidur. Post Stroke Sleep Disoder (PSSD) merupakan gejala tersering setelah stroke. Gangguan tidur setelah stroke meliputi Sleep Disordered Breathing (SDB), insomnia, circadian rhythm sleep disturbance, hipersomnia, parasomnia dan sleep-related movement disorder. Tidur memiliki banyak manfaat, salah satunya adalah restorasi fungsi fisik dan mental, konsolidasi memori dan meningkatkan kemampuan belajar dari seseorang baik secara motorik maupun sensorik. Penelitian lain pun menunjukkan adanya korelasi antara waktu tidur elektrografik dan fungsi kognitif dari pasien stroke pada masa pemulihan. Sebuah penelitian percobaan lain pula mengindikasikan bahwa gangguan tidur dapat meningkatkan ekspresi dari neurocan, yaitu gen yang menghambat pertumbuhan saraf. Gangguan tidur pada pasien stroke dapat menurunkan efisiensi dan efektifitas dari rehabilitasi stroke.Sleep Disorders in Acute Phase Stroke PatientsAbstractStroke is a condition when a person has a sudden neurological deficit caused by a disruption in the blood vessels of the brain. About 21-77% of stroke patients have sleep disorders that occur after a stroke. The sleep cycle is regulated by the brain and strokes can cause sleep disturbances due to abnormalities that can occur in the brain structures that regulate sleep. Post Stroke Sleep Disoder (PSSD) is the most common symptom after stroke. Sleep disorders after stroke include Sleep Disordered Breathing (SDB), insomnia, circadian rhythm sleep disturbance, hypersomnia, parasomnia and sleep-related movement disorders. Sleep has many benefits, one of which is the restoration of physical and mental functions, the consolidation of memory and improving the learning ability of a person both motorically and sensitively. Other studies have also shown a correlation between electrographic sleep time and cognitive function of stroke patients during recovery. Another experimental study also indicated that sleep disorders can increase the expression of neurocans, which are genes that inhibit nerve growth. Sleep disorders in stroke patients can reduce the efficiency and effectiveness of stroke rehabilitation

Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi Of Fallot Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
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Tetralogi of Fallot (TOF), pertama kali diperkenalkan pada tahun 1888 oleh seorang dokter dari Prancis yang bernama Etienne-Louis Arthur Fallot. Tetralogi of Fallot (TOF) merupakan salah satu jenis cacat jantung bawaan sianotik yang paling banyak diketemukan. Tetralogi of Fallot (TOF) memiliki empat kelainan yaitu: (1) stenosis infundibulum pulmonari, (2) Ventricular Septal Defect (VSD), (3) overidding aorta, dan (4) hipertrofi ventrikel kanan. Pasien dengan penyakit kongenital jantung sianotik (right to left shunt) memiliki resiko terjadinya abses otak. Penyakit jantung sianotik terhitung sekitar 12.8-69,4% dari semua kasus abses otak dan insidensi tertinggi terjadi pada anak-anak. Kami melaporkan seorang anak laki-laki berusia 8 tahun, berat badan 16 kg dengan abses otak multiple yang disertai dengan cacat jantung bawaan sianotik Tetralogi of Fallot (TOF) yang akan dilakukan aspirasi abses. Pasien datang dengan suhu tubuh 39oC, GCS 13, Tekanan darah 90/50 mmHg, nadi 120 x/menit, SpO2 90% dengan simple mask 6 L/menit. Hasil lab menunjukan Hb14gr%, Hematokrit 41%, thrombosit 250.000/mm3. PT/aPTT 13,2/26,9. Sudah terpasang infus dari UGD, selanjutnya diberikan premedikasi midazolam 1 mg intravena, induksi dengan propofol, fentanyl, vecuronium, rumatan anestesi dengan oksigenudara, sevoflurane. 12 Jurnal Neuroanestesia Indonesia Operasi berlangsung selama 1,5 jam, pemberian cairan dengan target normovolume, pascaoperasi dirawat di neurointensive care unit selama 3 hari. Puasa prabedah harus diperhitungkan sebaik-baiknya karena pasien harus tetap terhidrasi dengan baik. Pasien TOF dengan polisitemia, apabila terjadi dehidrasi akan meningkatkan viskositas dan sludging. Pasien ini sudah terhidrasi dengan baik dan cairan pengganti puasa diberikan melalui infus. Pasien harus dalam keadaan tenang dan rileks. Pasien diberikan premedikasi midazolam intravena. Premedikasi dengan suntikan intramuskuler harus dihindari karena kecemasan dan stress dapat menyebabkan tet spell. Premedikasi berat juga harus dihindari karena adanya depresi nafas yang menimbulkan hiperkarbia dapat meningkatkan Pulmonary Vascular Resistance (PVR) dan menimbulkan peningkatan shunting dari kanan ke kiri. Aspirasi abses serebri tidak dapat dilakukan dengan anestesi lokal karena akan meningkatkan kecemasan, tekanan darah pasien. Anestesi harus dilakukan dengan anestesi umum. Pengelolaan perioperatif pasien TOF yang dilakukan operasi ditempat lain (bukan operasi TOFnya) memerlukan pemahaman tentang patofisiologik TOF dan teknik neuroanestesi untuk mendapatkan outcome yang baik.Anesthesia Management For Brain Abscess Drainage Patient With Tetralogy Of FallotTetralogy of Fallot (TOF) was first described in 1888 by a French physician named Etienne-Louis Arthur Fallot. Tetralogy of Fallot (TOF) is one type of cyanotic congenital heart defect most widely found. Tetralogy of Fallot (TOF) has four abnormalities: (1) pulmonary infundibulum stenosis, (2) VSD (Ventricular Septal Defect), (3) overriding aorta, and (4) right ventricular hypertrophy. Patients with congenital cyanotic heart disease (right to left shunt) have a risk of brain abscess. The incidences of cyanotic heart disease is about 12.8-69,4% of all cases of brain abscess and the highest incidence occurs in children. We reported an 8-years old 16-kg boy with multiple brain abscesses accompanied with cyanotic congenital heart defect Tetralogy of Fallot (TOF) and whom abscess aspiration would be performed. Patients was present with body temperature 39oC, GCS 13, blood pressure 90/50 mmHg, pulse 120 beats/min, SpO2 90% with a simple mask using oxygenation of 6 L/min. Lab results showed Hb 14gr%, hematocrit 41%, platelet count 250.000/mm3, PT /aPTT: 13.2/26.9. Patient was mounted infusion from the emergency ward (ER), given 1 mg intravenous midazolam premedication, induction with propofol, fentanyl, vecuronium, maintenance with oxygen-air anesthesia and sevoflurane. The operation lasted for 1.5 hours, the infusion targeted to normal volume, postoperative care was given in the neurointensive care unit for 3 days. Pre-surgical fasting plan plays an important role because the patient must remains well hydrated. TOF patients with polycythemia when dehydrated, will increase the viscosity and sludging events. This patient was well hydrated and fasting replacement fluid therapy was given intravenously. Patients should be in a state of calm and relaxed. Patient was given intravenous midazolam premedication. Premedication with intramuscular injections should be avoided, since anxiety and stress may lead to "tet" spell. Heavy premedication should also be avoided because of respiratory depression leading to hypercarbia can increase the Pulmonary Vascular Resistance (PVR) and precipitate increased shunting from right to the left. Cerebral abscess aspiration can not be performed under local anesthesia because it increases the anxiety and the patient's blood pressure. Anesthesia should be performed under general anesthesia. Management of perioperative TOF patients who will underwent surgery elsewhere (not for TOF) requires deep understanding on TOF pathophysiology and neuro-anesthesia techniques to get a good outcome

Penatalaksanaan Cedera Otak pada Anak AR, Muhammad; Umar, Nazaruddin; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
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Trauma kepala (TBI) pada anak merupakan suatu problem khusus dalam neuroanestesi. Terdapat perbedaan anatomi, fisiologi dan fisikososial, disamping otak anak yang sedang mengalami perkembangan/pertumbuhan. Bila terjadi trauma akan menyebabkan angka mortalitas dan morbilitas serta angka kecatatan yang lebih tinggi, yang sangat berpengaruh pada perkembangan anak. Patah tulang kepala, perdarahan epidural, subdural dan intracerebral, edema otak akan menimbulkan gangguan pertumbuhan dan berefek pada organ-organ lain. Seorang anak laki-laki, 4 tahun 10 bulan, datang ke RS dengan mengalami penurunan kesadaran setelah terjatuh dari kendaraan karena kecelakaan lalu lintas. Datang ke rumah sakit lebih kurang 6 jam setelah kecelakaan, sebelumnya dirawat di rumah sakit terdekat. Pada pemeriksaan didapat GCS 10, pupil isokor 2/2mm, reflek cahaya +/+, hemodinamik dalam batas normal, anemia (+). Setelah dilakukan pemeriksaan fisik dan pemeriksaan tambahan didiagnosa kerusakan otak karena trauma (GCS 10) + didapatkan fraktur terbuka tulang frontoparietal kanan + fraktur tulang frontal kiri kontusio hemorrhagik + anemia. Dilakukan operasi debridemen dan koreksi fragmen tulang yang patah dengan bantuan anestesi umum. Pascabedah pasien di rawat di ICU dengan kesadaran meningkat, keadaan membaik. Kemudian pasien di pulangkan setelah 15 hari perawatan. Penanganan anestesi pada trauma kepala anak mempunyai problem khusus yang berbeda dengan dewasa, maka perlu pemahaman tentang anatomi, fisiologi dan psikologi yang baik dalam persiapan dan penatalaksanaan yang khusus sehingga dapat mencegah atau mengurangi kemungkinan terjadinya penyulit-penyulit post operasi.Management of Brain Trauma in Children AbstractHead trauma (TBI) in children is a particular problem in neuroanestesi. There are differences in anatomy, physiology and psychosocial, as well as children who are experiencing brain development / growth. In the event of trauma will cause mortality and morbidity and a higher rate, which is very influential in the development of children. Skull fracture, epidural hemorrhage, subdural and intracerebral, brain edema may lead to an effect on growth and other organ. A boy, 4 years 10 months, admitted to hospital with the experience a decrease in consciousness after falling from a vehicle due to traffic accidents. Come to the hospital approximately 6 hours after the accident, previously treated in nearly hospitals. On examination 10 obtained GCS, pupillary light reflex isocoor 2/2mm + / +, hemodynamics in the normal range, anemia (+). After a physical examination and was diagnosed with an additional examination brain damage due to trauma (GCS 10) + obtained frontoparietal bone fracture open fracture of the right frontal bone fracture + left + contusio hemorrhagic + anemia. Surgical debridement and correction of the broken bone fragments under general anesthesia. Post surgery patients cared for in ICUs with increased awareness, things got better. Then the patient at discharge after 15 days. Anesthesia management in head trauma the child has special problems that are different from adults. It is necessary to an understanding of the anatomy, physiology and psychology are both in preparation and stylists specifically so as to prevent or reduce the likelihood of postsurgery complications.

Trombosis Vena Otak Marwan, Kenanga; Jasa, Zafrullah Kany; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
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Trombosis vena otak (TVO) adalah trombosis pada vena otak dan sinus mayor duramater. Faktor resiko terjadinya TVO meliputi faktor genetik trombofilia dan penggunaan kontrasepsi hormonal. Manifestasi klinis TVO sangat bervariasi. Timbulnya gejala dan tanda bersifat akut, subakut, atau kronis. Empat sindrom utama yang muncul: hipertensi intrakranial terisolasi, kelainan neurologis fokal, kejang, dan ensefalopati. Sindrom ini dapat muncul dalam kombinasi atau terisolasi tergantung pada luas dan lokasi TVO. Tatalaksana fase akut dari TVO berfokus pada antikoagulan, manajemen dari sekuele seperti kejang, peningkatan tekanan intrakranial, dan infark vena.2 Penyebab utama kematian pasien TVO selama fase akut adalah herniasi transtentorial yang kebanyakan disebabkan karena perdarahan vena. Mayoritas pasien mengalami penyembuhan parsial dan sekitar 10% mengalami defisit neurologis permanen hingga 12 pasien terjadi pada bulan ketiga) dan akan terbatas setelahnya. Rekurensi dari TVO termasuk jarang (2,8%).Cerebral Venous ThrombosisCerebral venous thrombosis is a condition of thrombosis in cerebral veins and major sinus duramater. Risk factor of cerebral venous thrombosis include genetic factor like thrombophylia and hormonal contraception. There are variations in clinical manifestation of cerebral venous thrombosis. The sign and symptom could be divided into acute, subacute or chronic onset. There are 4 syndroms of clinical manifestations of cerebral venous thrombosis: isolated intracranial hypertension, focal neurologic deficits, seizure, and encephalopathy. The focus of treatment in cerebral venous thrombosis is anticoagulant therapy, sequele of seizure, to treat intracranial hypertension and venous infract. The main cause of death patient with acute onset cerebral venous thrombosis is transtentorial herniation due to venous bleeding. Partial recovery happens in mostly patient with cerebral venous thrombosis anda about 10% had permanent neurologic deficits untill 12 moths. Recanalisation occurs in the first month after cerebral venous thrmbosis (84% patient in the third month) and limited after that. Cerebral venous thrombosis recurrency is rare (2,8%).

Korelasi antara Rentang Waktu Cedera Otak Traumatik dengan Dimulainya Terapi Pembedahan Kraniotomi terhadap Kejadian dan Beratnya Post Traumatic Headache (PTH) Halimi, Radian Ahmad; Fuadi, Iwan; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Latar Belakang dan Tujuan: Keluhan nyeri kepala setelah terjadinya Cedera Otak Traumatik (COT) dikenal sebagai Post Traumatic Headache (PTH) yang dapat terjadi setelah cedera kepala ringan, sedang, atau berat. Tujuan penelitian ini adalah mencari apakah ada korelasi antara rentang waktu kejadian COT hingga dilakukannya terapi pembedahan kraniotomi terhadap angka kejadian dan beratnya PTH. Subjek dan Metode: Penelitian observasional kohort prospektif pada 33 orang pasien COT derajat ringan atau sedang dengan pengambilan data secara consequetif sampling. Parameter yang dicatat dalam penelitian ini antara lain usia, jenis kelamin, berat badan, GCS, rentang waktu dari kejadian COT hingga dilakukannya terapi pembedahan kraniotomi, angka kejadian PTH, derajat berat nyeri dengan menggunakan sistem penilaian Numeric Rating Scale (NRS). Analisis korelasi linear dua variabel dihitung berdasarkan analisis korelasi Spearman. Hubungan korelasi bermakna bila koefisien korelasi (R) 0,4 dan nilai p0,05. Hasil: Hasil penelitian menunjukkan adanya korelasi yang kuat antara rentang waktu terhadap kejadian PTH (r = 0,75) dengan korelasi searah dan bermakna (p0,05). Terdapat korelasi yang kuat antara rentang waktu terhadap derajat beratnya PTH (r = 0,82) dengan korelasi searah dan bermakna (p0,05). Simpulan: semakin lama rentang waktu dari kejadian COT hingga dilakukannya terapi pembedahan kraniotomi maka akan semakin banyak angka kejadian dan semakin berat PTH.The Correlation between The Interval of Traumatic Brain Injury with Craniotomy Surgery Start on The Incidence and Severity of Post Traumatic Headache (PTH)Background and Objective: Complaints of headache in the aftermath of Traumatic Brain Injury (TBI) is known as Post Traumatic Headache (PTH), which can occur after mild, moderate, or severe head injury. The purpose of this study is to find a correlation between the time span from the TBI events until the craniotomy surgical therapy was performed with the incidence and severity of PTH.Subject and Method: Prospective observational cohort study in 33 patients with mild or moderate TBI with data retrieval consequetif sampling. The parameters recorded in this study including age, gender, weight, GCS, time interval between the events of TBI until the craniotomy surgical therapy was performed, the incidence of PTH, severity of pain using NRS score. Analysis of linear correlation of two variables calculated by Spearman correlation analysis. Significant correlation when the correlation coefficient (R) 0.4 and p 0.05.Result: The results showed a strong correlation between the interval of the incidence with the incidence of PTH (r = 0.75) with unidirectional and significant correlation (p 0.05). There is a strong correlation between the time span from TBI events until the craniotomy surgical therapy with the severity of PTH (r = 0.82) with unidirectional and significant correlation ( p 0.05).Conclusions: the longer of interval between the TBI events to craniotomy surgical treatment, the more of the incidence and severity of PTH.

Penatalaksanaan Anestesi pada Perdarahan Intraserebral dengan Hidrosefalus dan Diabetes Melitus Longdong, Djefri Frederik; Rachman, Iwan Abdul; Bisri, Dewi Yulianti; Sudadi, Sudadi; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Perdarahan Intraserebral (PIS) adalah ekstravasasi darah yang masuk kedalam parenkim otak, yang dapat berkembang ke ruang ventrikel dan subarahnoid, terjadi spontan dan bukan disebabkan oleh trauma (non traumatis) dan merupakan salah satu penyebab tersering pada pasien yang dirawat di unit perawatan kritis saraf. Kejadian PIS 10-15% dari semua stroke dengan tingkat angka kematian tertinggi dari subtipe stroke dan diperkirakan 60% tidak bertahan lebih dari satu tahun. Kasus: Laki-laki 57 tahun, datang dengan keluhan penurunan kesadaran yang terjadi pada saat mau makan. Pada pemeriksaan didapatkan kesadaran GCS E1M4V1 dengan hemodinamik stabil, dan terdapat hemiplegi sinistra. Pasien diintubasi dan memakai ventilator di ruangan Instalasi Gawat Darurat Disaster sambil menunggu hasil skrining Covid 19 dengan swab polymerase chain reaction (PCR). Pada CT-scan ditemukan adanya PIS 48,93 cc di basal ganglia, capsula eksterna sampai periventrikel lateralis kanan, terjadi distorsi midline sejauh 1 cm ke kiri. Ventrikulomegali disertai perdarahan intraventrikel yang mengisi ventrikel lateralis kanan dan kiri, ventrikel III dan IV. Laboratorium menunjukkan gula darah di atas 200 mg/dl setelah dilakukan koreksi gula darah diputuskan untuk dilakukan tindakan kraniotomi evakuasi segera dengan pemeriksaan penunjang yang cukup. Tindakan kraniotomi evakuasi pada pasien PIS menjadi tantangan bagi seorang anestesi, sehingga diperlukan pengetahuan akan patofisiologi, mortalitas PIS dan tindakan anestesi yang harus dipersiapkan dan dikerjakan dengan tepat.Anesthesia Management in Intracerebral Hemorrhage with Hydrocephalus and Diabetes MellitusAbstractIntracerebral hemorrhage (ICH) is the extravasations of blood into the brain parenchyma, which may develop into ventricular and subarachnoid space, there was spontaneous and not caused by trauma (nontraumatic), and one of the most common cause in patients treated in the neurological critical care unit. ICH represents perhaps 1015% of all strokes with the highest mortality rates of stroke subtypes and about 60% of patients with ICH do not survive beyond one year. Case: a man 57 years, came with complaints of loss of consciousness when he just want to eat. On examination of consciousness obtained GCS E1M4V1 with hemodynamic was stable, there left hemiplegic. Patients is intubated and connected with ventilator at Emergency Room Disaster while waiting for result from PCR. From the CT Scan we found 48,93 cc at basal ganglia, capsula externa until lateral periventricle dextra there is a midline distortion 1 cm to the left. Ventriculomegali with intraventricle hemorrhage wich is fill the lateral ventricle right and left, third ventricular and fourth ventricular. The laboratorium result show the glucose up to 200 mg/dl. After glucose correction, it was decided to evacuate immediately craniotomy action with adequate investigation. Procedure of craniotomy evacuation in ICH patients be a challenge for an anesthesiologist, so knowledge of the pathophysiology, mortality ICH and anesthetic procedure that should be prepared and done properly.

Penatalaksanaan Perioperatif Cedera Otak Traumatik pada Pasien Berusia Lanjut Adriman, Silmi; Umar, Nazaruddin; Rasman, Marsudi
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
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Data epidemiologi terus menunjukkan peningkatan populasi penduduk berusia lanjut dan berdampak pada peningkatan permintaan layanan kesehatan, termasuk kebutuhan untuk menjalani prosedur pembedahan karena berbagai sebab. Salah satu penyebabnya adalah cedera otak traumatik (COT), termasuk di dalamnya perdarahan epidural, subdural dan intraserebral (epidural, subdural, intracerebral hemorrhage/EDH, SDH, ICH). Pada pasien berusia lanjut, COT bertanggung jawab terhadap lebih dari 80.000 kasus dengan tiga-perempat diantaranya harus menjalani rawat inap setiap tahunnya. Perencanaan penatalaksanaan perioperatif membutuhkan pertimbangkan beberapa hal untuk mencapai tingkat anestesi dan analgesi yang optimal pada pasien berusia lanjut. Seorang laki-laki, 65 tahun, dibawa ke rumah sakit dengan penurunan kesadaran pasca kecelakaan bermotor. Setelah resusitasi dan stabilisasi didapatkan jalan napas bebas, laju pernapasan 18 kali/menit, tekanan darah 140/80 mmHg, laju nadi 88 kali/menit. Pada pasien dilakukan tindakan kraniotomi evakuasi EDH dan kraniektomi evakuasi SDH dan ICH dengan anestesi umum dan dengan memperhatikan prinsip neuroanestesi serta geriatri anestesi selama tindakan bedah berlangsung.Perioperative Management of Traumatic Brain Injuryin Elderly Surgical PatientsCurrent epidemiological data showed an increasing number of elderly population, whereas in accordance with an increased demand for health care service, including surgical treatments for elderly. Traumatic brain injury (TBI), such as epidural hemorrhage (EDH), subdural hemorrhage (SDH) and intracerebral hemorrhage (ICH) are among the demanded surgery in elderly. In elderly population, TBI is responsible for more than 80.000 emergency department cases each year; with approximately three-quarters of these cases require further hospitalization. Perioperative management planning requires some considerationsin order to achieve the optimal level of anesthesia and analgesia in the elderly patients. A 65 years old male patient was admitted to the hospital with decreased level of consciousness after motor vehicle traffic injury. During resuscitation, airway was clear, respiratory rate was 18 x/min, blood pressure was 140/80 mmHg, heart rate was 88 x/min. Patient directly underwent an emergency craniotomy evacuation of EDH, SDH and ICH under general anesthesia with continue and comprehensive care of neuroanesthesia and geriatric anesthesia principles.

Hubungan antara Skor GCS dengan Skor NRS PTH Akut pada Pasien COT di RSUD Ulin Banjarmasin Nur Alaina, Ilma Fi Ahsani; Sikumbang, Kenanga M.; Asnawati, Asnawati
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
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Latar Belakang dan Tujuan: Cedera otak traumatik (COT) dapat dinilai menggunakan skor Glasgow Coma Scale (GCS). Adanya mekanisme cedera sekunder yang berkembang dalam beberapa hari menjadi faktor pencetus munculnya keluhan Post Traumatic Headache (PTH) akut. Keparahan nyeri yang dikeluhkan pada pasien PTH dapat dinilai berdasarkan skor Numeric Rating Scale (NRS). Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara skor GCS dengan skor NRS PTH akut pada pasien COT di RSUD Ulin BanjarmasinSubjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional dengan 40 sampel diperoleh secara consecutive sampling dan sebanyak 36 pasien (90%) mengeluhkan PTH akut. Analisis data penelitian ini menggunakan uji one-way anova.Hasil: Hasil penelitian menunjukkan nilai p=0,558 pada pasien COT yang dilakukan tataksana operatif dan p=0,732 pada tatalaksana konservatif.Simpulan: Dapat disimpulkan bahwa tidak terdapat hubungan antara skor GCS dengan skor NRS PTH akut pada pasien COT di RSUD Ulin Banjarmasin.Associations between GCS Score and NRS Score of Acute PTH in TBI Patients at Ulin General Hospital BanjarmasinAbstractBackground and Objective: Traumatic brain injury (TBI) is an alteration in brain function caused by external physical forces that its severity can be assessed using the Glasgow Coma Scale (GCS) score. The secondary injury can develop in a few days and may trigger the appearance of acute Post Traumatic Headache (PTH). The severity of PTH can be assessed using the Numeric Rating Scale (NRS) score. The purpose of this study was to determine whether there is an association between GCS score and NRS score of acute PTH in TBI patients at Ulin General Hospital Banjarmasin.Subject and Methods: This study used an analytic observational method with cross sectional approach. A total of 40 samples were obtained with a distribution of 36 patients (90%) complained acute PTH.Results: Data analysis in this study using the one-way anova test showed p value = 0,558 on patients with operative management and p value = 0,732 on conservative management.Conclusion: It can be concluded that there is no association between GCS score with NRS score of acute PTH in TBI patients at Ulin General Hospital Banjarmasin.

Penatalaksanaan Anestesi untuk Tindakan Anterior Cervical Dissection Fussion pada Pasien dengan Fraktur Kompresi Vertebra Servikalis 5 Suyasa, Agus Baratha; Wargahadibrata, A. Himendra
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Kasus trauma masih merupakan penyebab kematian terbesar di dunia. Di Amerika lebih dari 90.000 orang meninggal setiap tahunnya karena kasus trauma, yang paling sering karena kecelakaan kendaraan bermotor dan kasus kekerasan. Diperkirakan 20% dari korban tersebut mengalami trauma multipel dan juga mengalami cedera medula spinalis. Sekitar 55% cedera pada tulang belakang terjadi pada daerah servikal dan diperkirakan 5% dari penderita cedera kepala juga mengalami cedera pada tulang belakang. Seorang laki-laki 21 tahun akan dilakukan operasi Anterior Cervical Dissection Fussion (ACDF) karena mengalami cedera medula spinalis lesi inkomplit Frankle C karena fraktur kompresi vertebra servikalis 5. Tujuh hari sebelum masuk rumah sakit penderita jatuh dari atap rumah. Keluhan utama 2 Jurnal Neuroanestesia Indonesia yang dirasakan tangan dan kaki tidak dapat digerakan. Operasi dilakukan dengan anestesi umum, menggunakan pipa endrotrakeal no 7,5, dengan ventilasi kendali. In line position saat melakukan laringoskopi intubasi. Premedikasi dengan fentanyl 100 _g, lidokain 1,5 mg/KgBB 3 menit sebelum intubasi, induksi dengan propofol 100 mg. Fasilitas intubasi menggunakan atrakurium 0,5 mg/KgBB. Pemeliharaan anestesi dengan O2, N2O, Isofluran serta propofol kontinyu 100 mg /jam. Selama operasi hemodinamik stabil, tekanan darah sistolik 90-125 mmHg, tekanan darah diastolik 42-78 mmHg, laju nadi 62-82 x/mnt dan SpO2 99%. Ekstubasi dilakukan di kamar operasi segera setelah operasi selesai. Post operasi pasien dirawat di NCCU. Struktur anatomi tulang servikal yang tipis sangat memudahkan terjadinya fraktur, sehingga medula spinalis pun sangat mudah mengalami cedera. Jaringan saraf dapat mengalami cedera akibat peregangan, kompresi maupun laserasi. Disrupsi fisikal pada medula spinalis dapat menyebabkan kehilangan fungsi secara komplit dan irreversibel. Prinsip utama penatalaksanaan penderita dengan cedera medula spinalis pada fraktur tulang belakang adalah tidak memperburuk cedera medula spinalis yang sudah terjadi serta melakukan proteksi terhadap medula spinalis baik secara mekanik maupun kimiawi. Mempertahankan aliran darah medula spinalis dan mencegah edema pada medula spinalis merupakan salah satu prinsip penting dalam proteksi medula spinalis dan memperbaiki outcome pasien. Assesmen awal terhadap pasien yang mengalami fraktur tulang servikal selalu dimulai dari airway, breathing, circulation dan kemudian resusitasi dilakukan secara simultan. Ekstensi dan traksi axial yang berlebihan harus dihindari. Stabilisasi dapat dilakukan dengan pemasangan servikal collar atau manual in line pada saat laringoskopi intubasi. Perhatikan komplikasi syok spinal dan cedera medula spinalis. Pemilihan obat-obat anestesi yang memiliki efek proteksi terhadap medula spinalis.Anesthetic Management for Anterior Cervical Dissection Fusion Procedure in Patient with Compression Fracture of the 5th Cervical SpineTrauma is still the most cause of death in the world. In America more than 90,000 people die because of trauma, mostly traffic accident and violence. Around 20% of the victim had multiple trauma and spinal cord injury. Around 55 % patient of spine injury was located at cervical part and 5% of patientwith head injury should have spine injury. A male, 21 years old, with spinal cord injury incomplete lesion Frankle C because of compression fracture of the 5th cervical spine undergone ACDF (Anterior Cervical Dissection Fusion) procedure. Seven days before enter the hospital, the patient has fell down from the roof. He was unable to move his hands and legs. The procedure was perform in general anesthesia, using ETT No 7,5, controlled ventilation. In line position while performed laringoscopy intubations. Fentanyl 100 ?g intravenous, lidocain 1,5 mg/Kg 3 minutes before intubations has used as premedications. Induction of anesthesia was performed with propofol 100mg and atracurium 0,5mg/Kg for intubations facilitation. Maintenance of anesthesia was used O2, N2O, Isoflurane and Propofol 100 mg/hour. During the operation, haemodynamic remain stable, systolic blood pressure 90 125 mmHg, diastolic blood pressure 42-78 mmHg, heart rate 62-82 bpm and SaO2 99 %. The patient was extubated in the operating theatre after the end of surgery. Post operative patient was transferred to the NCCU. Anatomic structure of the cervical spine are thin, these make them vulnerable to injury. The spinal cord is vulnerable also when fracture of the spine occur. Spinal cord and the neuronal tissue may injure from stretching, compression and laceration. Physical disruption of spinal cord can cause the complete and irreversible loss of function. The main principle in manage spine fracture do not worsen the existing spinal cord injury by protecting the spinal cord mechanically and chemically. Maintain the spinal cord blood flow and prevent the edema may improve the patient outcome. Early assessment for spine fracture including airway, breathing and circulation must be done, and resuscitation performed simultaneously. Excessive extension or axial traction must be avoided. Stabilization of the spine can be done by cervical collar or manual in line position during intubations. Prevent the spinal shock complication and further spinal cord injury. Use the anesthetic agent which has the spinal cord protection effect.

Manajemen Tekanan Darah Setelah Cedera Sistem Saraf Pusat Radian Ahmad Halimi; Dewi Yulianti Bisri
Jurnal Neuroanestesi Indonesia Vol 8, No 2 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Hipertensi yang tidak terkontrol sering dijumpai setelah cedera otak. Mekanisme mengenai respon fisiologis dan patologis ini berhubungan dengan respons autoregulasi yang bertujuan untuk mempertahankan aliran darah otak di area yang terkena cedera. Respons hipertensi awal mungkin akan mempercepat/memicu cedera lebih lanjut. Sebaliknya, penurunan tekanan darah secara agresif justru berhubungan dengan kejadian iskemik. Meskipun tekanan darah sudah jelas berperan sebagai modulator dalam cedera otak akut, berbagai penelitian masih menunjukkan kontroversi dan belum ada data-data berkualitas terkait demografis, manajemen optimal terhadap tekanan darah tinggi dam hasil akhir pada pasien yang mengalami cedera otak akut. Deteksi kelainan autoregulasi yang terjadi setelah cedera otak dan kontrol tekanan darah secara hati-hati sangat dibutuhkan dalam manajemen optimal pasien tersebut. Blood Pressure Management After Central Nervous System InjuryAbstractUncontrolled hypertension is often encountered after brain injury. This mechanism related to physiologic and pathologic response are related to autoregulatory responses aimed at preserving the cerebral blood flow in injured areas. The initial hypertensive response may precipitate further injury. Conversely, aggresive blood pressure reduction may be associated with ischemia. Despite the clear role of blood pressure as a modulator of acute brain injury, there is considerable controversy and a lack of high-quality data regarding the demographics, outcomes, and optimal management of high blood pressure in acute brain-injured patients. Recognition of the autoregulatory abnormalities seen after brain injury and careful control of blood pressure are necessary for the optimal management of these patients.

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Home Page

OAI Link

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Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

Phone +6287722631615

Journal Mail Official jni@inasnacc.org

Editorial Address Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

Location , INDONESIA

Abstract

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Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

Phone
+6287722631615

Journal Mail Official
jni@inasnacc.org

Editorial Address
Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

Location
,

INDONESIA