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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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Hubungan Skor GCS dengan Fungsi Kognitif pada Pasien Cedera Otak Traumatik di IGD RSUD Ulin Banjarmasin Kartinasari, Apidha; Fakhrurrazy, Fakhrurrazy; Sikumbang, Kenanga M.
Jurnal Neuroanestesi Indonesia Vol 9, No 1 (2020)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (83.27 KB) | DOI: 10.24244/jni.v9i1.209

Abstract

Latar Belakang dan Tujuan: Cedera Otak Traumatik (COT) merupakan cedera yang mempengaruhi tingkat kesadaran serta fungsi neurologis. Pemeriksaan GCS dilakukan untuk mengkategorikan keparahan yang terjadi pada COT. Kondisi pasca COT dapat menyebabkan terjadinya penurunan fungsi kognitif karena terjadi kerusakan pada sel-sel otak serta vaskularisasinya. Tujuan penelitian ini untuk mengetahui apakah terdapat hubungan antara skor GCS dengan pemeriksaan fungsi kognitif menggunakan Mini Mental State Examination (MMSE) dan Clock Drawing Test (CDT) pada pasien COT di Instalasi Gawat Darurat (IGD) RSUD Ulin Banjarmasin.Subjek dan Metode: Penelitian ini bersifat observasional analitik dengan pendekatan cross sectional. Sebanyak 48 sampel didapatkan secara consecutive sampling.Hasil: Pada COT ringan terdapat 2 pasien (10%) mengalami penurunan fungsi kognitif, COT sedang 15 pasien (83,3%), dan COT berat 9 pasien (90%). Analisis data menggunakan uji Chi-Square dengan tingkat kepercayaan 95% menunjukkan penurunan fungsi kognitif seiring dengan semakin beratnya COT (p=0,000).Simpulan: Terdapat hubungan antara skor GCS dengan fungsi kognitif menggunakan MMSE dan CDT pada pasien COT.Relationship between Glasgow Coma Scale (GCS) Score with Cognitive Function in Traumatic Brain Injury Patient at Emergency Department of Ulin General Hospital BanjarmasinAbstractBackground and Objective: Traumatic Brain Injury (TBI) is an injury that affects the level of consciousness and neurological function. GCS examination is done to categorize the severity that occurs in TBI. Conditions after traumatic brain injury cause cognitive function impairment due to damage of brain cells and its vascularization. Analyze the relationship between GCS scores and cognitive function test using MMSE and CDT in TBI patients.Subject and Method: This study was observational analytic in design with a cross sectional approach. A total of 48 samples were obtained by consecutive sampling.Result: In mild TBI there were 2 patients (10%) experienced decrease in cognitive function, moderate TBI was 15 patients (83.3%), and 9 patients (90%) in severe TBI. Data analysis used Chi-Square test with 95% confidence level which showed a decrease in cognitive function along with the increasing severity of TBI (p=0.000). Conclusion: There was a relationship between GCS scores and cognitive function using MMSE and CDT in TBI patients.
Pengelolaan Perioperatif Anestesi Perdarahan Intraserebral karena Stroke Perdarahan dan Luarannya Basuki, Wahyu Sunaryo; Bisri, Dewi Yulianti; Oetoro, Bambang J.; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3602.902 KB) | DOI: 10.24244/jni.vol5i1.61

Abstract

Perdarahan intraserebral masih merupakan penyebab kematian dan kecacatan yang tinggi. Angka kejadiannya berkisar 1030 % kasus per 100.000, dengan angka kematian mencapai 62% dan hanya 20% yang bisa bertahan hidup secara fungsional dalam 6 bulan dari onset. Penyebab dari perdarahan intraserebral adalah hipertensi. Pengelolaan perioperatif meliputi pencegahan bertambahnya hematom dan edema, pengelolaan tekanan darah, mencegah naiknya ICP dan mempertahankan tekanan perfusi otak. Seorang laki-laki dibawa ke rumah sakit karena lemah anggota gerak kanan atas dan bawah dan tidak bisa bicara sejak 2 jam sebelumnya. Dari anamnesa didapat riwayat hipertensi dalam 5 tahun terakhir dan mendapat obat bisoprolol. Dari pemeriksaan didapatkan kesadaran dengan GCS E4 M5Vx, hemiplegi dekstra dan afasia, tekanan darah 180/105 mmHg. Pasien di rawat diruangan intermediate di ICU. Pada hari kedua karena ada penurunan kesadaran dengan GCS E3 M4 Vx serta penambahan hematoma menjadi 87 cc dibanding MRI sebelumnya diputuskan segera dilakukan kraniotomi evakuasi. Tindakan ini memerlukan pengetahuan yang baik mengenai pengelolaan perioperatif pasien dengan perdarahan intraserebral karena hipertensi dari seorang ahli Anestesiologi sehingga mendapat luaran yang baik.Anesthetic Perioperative Management of Intracerebral Hemorrhage and its OutcomeIntracerebral hemorrhage (ICH) has high mortality and morbidity rates. Its incidence is 10-30%, with a mortality rate of 62%. Only 20% of patients survive functionally within six months from time of onset. The cause of ICH is hypertension. Perioperative management of ICH includes blood pressure control, prevention of hematoma enlargement and edema, prevention of ICP increase and maintenance of cerebral perfusion pressure. A male patient was brought to the hospital due to weakness of the left extremities and inability to speak since two hours before admission. Patient had had hypertension for the last five years and was on bisoprolol. Physical examination revealed GCS E4M5Vx, left hemiplegia, aphasia, and blood pressure 180/105 mmHg. Patient was admitted to intermediate ward in the intensive care unit. On day-2, due to further decrease in consciousness (GCS E3M4Vx) and increase in hematoma volume to 87 cc, craniotomy for evacuation was indicated. This procedure requires good understanding of perioperative management of ICH by an anesthesiologist to produce favorable outcome.
Ventilasi Mekanis pada Pasien Cedera Otak Traumatik dengan Gagal Nafas M. Helmi; Diederik Gomers
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (10065.933 KB) | DOI: 10.24244/jni.vol2i1.191

Abstract

Gagal nafas dapat terjadi secara mandiri atau dapat pula sebagai akibat dari cedera kepala. Pada kondisi dimana kedua hal tersebut terjadi secara bersamaan, pengeloaaan ventilasi mekanis menjadi lebih rumit, karena penatalaksaaan respisari dapat mempengaruhi fugsi serebral, dan sebaliknya. Penatalaksanaan mode ventilasi mekanins, termasuk besarnya volume tidal, pola ventilasi, oksigenasi dan positive end expiratory pressure (PEEP) tewlah diketahui berperan terhadap perubahan tekanan intracranial, sehingga harus disesuaikan untuk paisen ini. Disarankan untuk menggunakan strategi ventilasi mekanis dengan volume tidal rendah dan frekuensi nafas tinggi/ (hiperventilasi) untuk menjaga volume semenit yang adekuat dan menurunkan PaCO2. Hiperventilasi dianjurkansebagai salah satu cara  untuk mencegah ischemia demi mencegah rendahnya nilai aliran darah otak pada periode 24 jam pertama setelah omset trauma. Hanya saja, sampai saat ini belum ada ketetapan mengenai nilai optomal PEEP yang disarankan untuk pasien dengan cedera otak traumatik ini. Dalam hal ini disarankan mencari nilai PEEp minimal yang masih dapat mencegah kolpas alveoli, tetapi tidak mengganggu hemodinamik. Lebih lanjut lagi telah ada beberapa laporan kebersihan dari penggunaan tehnik ventilasi mekanis mutakhir seperti HFOV, pECLA dan ECMO. Tinjauan pustakan iniu akan memaparkan informasi  penatalaksanaan pasien dengan kondisi ini.Mechanical Ventilation for Traumatic Brain Injured Patients with Respiratory FailureRespiratory failure can occur independently or due to brain injury. The management of mechanical ventilation in these patients became more complicated when both together are occurred. This is due to the management of respiratory may be effected by cerebral function, and vice versa. Ventilation modes, which include the amount of given tidal volume, ventilation pattern, oxygenation and positive end expiratory pressure (PEEP) have been well known to contribute in the changes of intracranial pressure. It is advise to perform hyperventilation with low tidal volume in order to keep an adequate minute ventilation and reduced PaCO2. Hyperventilation is suggested to prevent ischemia by preventing the reduction of cerebral blood flow during the first 24 hours after the onset of trauma. Unfortunately, there  is still no evidence of the best PEEP to be used in this patient. Therefore, it is advised to find the minimum PEEP, which prevents collapsed alveoli, with less hemodynamic effects. Furthermore, there are several successful reports in the use of advances mechanical ventilation techniques in these patients, such as HFOV, pECLA and ECMO. This review will inform the management of mechanical ventilation for brain injured patients with respiratory failure.
Perbandingan Status Nutrisi Minggu Pertama pada Pasien Pascacedera Otak Traumatik Sedang dan Berat yang Dirawat di RSUP Dr. Hasan Sadikin Bandung Dinilai dengan Subjective Global Assessment (SGA) Saputra, Tengku Addi; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1448.211 KB) | DOI: 10.24244/jni.vol7i3.16

Abstract

Latar Belakang dan Tujuan: Penilaian status nutrisi merupakan hal vital untuk menentukan rencana pemberian nutrisi dan memperbaiki luaran pasien dengan cedera otak traumatik (COT). Pada pasien COT terjadi hipermetabolisme, hiperkatabolisme, dan intoleransi glukosa yang dapat mempengaruhi luaran pasien. Penilaian status gizi dilakukan dengan Subjective Global Assessment (SGA). Tujuan penelitian ini adalah untuk membandingkan status nutrisi antara pasien COT sedang dan berat yang dinilai dengan SGA.Subjek dan Metode: Penelitian observasional analitik cross sectional ini dilakukan pada 22 pasien COT yang dirawat di RSUP Dr Hasan Sadikin Bandung sejak November 2016 - Juli 2017, yang dibagi menjadi 2 kelompok, yaitu COT sedang dan berat. Status nutrisi subjek penelitian dinilai dengan SGA selama 7 hari. Analisis data dilakukan dengan Chi Square, Kolmogorof-Smirnof dan Exact Fisher. Hasil: Terdapat perbedaan status nutrisi yang signifikan antara kelompok COT sedang dan berat pada hari perawatan ke-6 dan 7, dimana lebih banyak didapatkan malnutrisi berat pada kelompok COT berat (p0,05).Simpulan: Pada penelitian ini malnutrisi lebih banyak terjadi pada pasien dengan COT berat, disebabkan oleh perlambatan pemberian nutrisi akibat disfungsi gastrointestinal yang terjadi pada pasien COT berat sehingga diperlukan strategi pemberian nutrisi khusus pada kelompok COT berat.Comparison of a One Week Nutritional Status between Moderate and Severe Traumatic Brain Injury Patient in Dr. Hasan Sadikin General Hospital Assessed with Subjective Global Assessment (SGA)Background and Objective: Assessment of nutritional status is vital in determining nutritional plans and improving outcomes of traumatic brain injury (TBI) patients. Hypermetabolism, hypercatabolism, and glucose intolerance occur in patients with TBI can affect its outcome. The used nutritional status assessment is Subjective Global Assessment (SGA). The aim of this study was to compare nutritional status in moderate and severe TBI patients assesed with SGA.Subject and Method: This cross sectional observational analytic study was conducted on 22 TBI patients treated in RSUP DR. Hasan Sadikin Bandung since November 2016 - July 2017, divided into 2 groups, moderate and severe TBI. Assessment of SGA in study subjects was conducted for 7 days. Data was analyzed with Chi Square, Kolmogorof-Smirnof and Exact Fisher test. Results: This study showed a significant difference in nutritional status between moderate and severe TBI groups during the 6th and 7th treatment days, whereas more severe malnutrition was found in the severe TBI group (p 0.05).Conclusion: Compares to patients with moderate TBI, malnutrition is more prevalent in patients with severe TBI, because of delayed of nutrient delivery due to gastrointestinal dysfunction occurring in severe TBI patients requiring specific nutritional strategies in severe TBI group.
Implikasi Anestesi Pasien Cedera Kepala Traumatik dengan Penyakit Jantung Bawaan (PJB) Sianotik: Masalah Hiperviskositas Darah Suyasa, Agus Baratha; Umar, Nazaruddin; Oetoro, Bambang J.
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (272.383 KB) | DOI: 10.24244/jni.vol2i3.159

Abstract

Saat ini banyak penderita penyakit jantung bawaan (PJB) yang mampu bertahan sampai dewasa (1525%). Penderita PJB memiliki anatomi serta fisiologi yang kompleks dan spesifik dengan morbiditas dan mortalitas perioperatif yang tinggi. Anak-anak dengan PJB meningkatkan resiko henti jantung serta mortalitas 30 hari setelah pembedahan mayor maupun minor dibandingkan dengan anak-anak yang sehat. Cedera otak traumatik merupakan salah satu kondisi yang mengancam jiwa dan merupakan penyebab utama kecacatan serta kematian pada dewasa dan anak-anak. Edema serebral sering ditemui dalam praktek klinis serta dapat menimbulkan masalah besar termasuk iskemia serebral, yang memperburuk aliran darah otak regional dan global, pergeseran kompartemen intrakranial akibat peningkatan tekanan intrakranial (TIK) sehingga menekan struktur vital otak. PJB sianotik memiliki kadar hematokrit yang meningkat dan diasumsikan berhubungan dengan resiko trombosis serebral dan stroke. Peningkatan massa sel darah merah dicurigai sebagai penyebab sindroma hiperviskositas dimana kadar hematokrit selanjutnya menjadi faktor resiko tejadinya infark serebral. Terdapat hubungan yang signifikan antara aliran darah otak dan kadar hematokrit namun belum jelas dinyatakan dalam literatur berapa batas kadar hematokrit, dan kriteria untuk dilakukan phlebotomi. Namun beberapa argumentasi menyatakan polisitemia (kadar hematokrit 60%) memiliki efek yang merugikan dan harus diturunkan dengan phlebotomi karena kompensasi yang berlebihan akan mengganggu aliran darah regional serta aliran darah serebralAnesthesia Implication in a Traumatic Brain Injury Patient with Cyanotic Congenital Heart Disease (CHD): Blood hyperviscosity problem Many patients with congenital heart disease (CHD) survive to adulthood period (1525%). Patients with CHD have a complex and specific anatomy and physiology with high perioperative morbidity and mortality. Children with congenital heart disease have an increased risk of cardiac arrest and 30 days mortality after both major and minor surgeries compared to healthy children. Traumatic brain injury is one of a life-threatening conditions which is the leading cause of disability and death in both adults and children. Cerebral edema is commonly encountered in clinical practice which have potential to cause major problems including cerebral ischemia, which was worsen the regional and global cerebral blood flow, intracranial compartment shift due to an increase in intracranial pressure (ICP) therefore pressing the vital structures of the brain. Cyanotic congenital heart disease patients have an increased hematocrit levels and this is assumed to be related to the risk of cerebral thrombosis and stroke. Increased red blood cell mass is suspected as the cause of hyperviscosity syndrome in which the hematocrit levels is a further risk factor for cerebral infarction is a significant relationship between cerebral blood flow and hematocrit levels. However the haematocrit unit and criterias for phlebotomy has not been explicitly stated in the literature. Some arguments stated that polycythemia (hematocrit levels 60%) had an adverse effect and should be reduced by phlebotomi as excessive compensation would disrupt the regional blood flow and cerebral blood flow.
Manajemen Anestesi Reseksi Tumor Cerebello-pontine Angle Vestibular Schwannoma dengan Posisi Lateral Suarjaya, I Putu Pramana; Paramartha, Bagus; J Sutawan, Ida Bagus Krisna; Panji, I Putu Agus Surya
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (492.324 KB) | DOI: 10.24244/jni.v11i2.477

Abstract

Tumor Cerebello-pontine angle (CPA) adalah tumor yang paling sering terjadi di daerah fossa posterior, dan berkisar 5-10 % dari seluruh kasus tumor intrakranial. Sebagian besar tumor CPA adalah tumor jinak, 85% diantaranya merupakan vestibular schwannoma (neuroma akustik). Terapi pilihan untuk tumor CPA vestibular schwannoma dengan gejala adalah tindakan pembedahan. Kraniotomi dengan posisi lateral penuh pada reseksi vestibular schwannoma yang berlangsung lama memberikan tantangan karena potensi terjadinya ketidaksesuaian ventilasi-perfusi dan atelektasis paru sisi bawah. Seorang pasien perempuan, usia 25 tahun, dengan gangguan pendengaran, gangguan keseimbangan, kelemahan separuh badan kiri, mengalami kesulitan menelan dan pada pemeriksaan magnetic resonance imaging (MRI) didapatkan lesi padat di cerebelo-pontine angle dengan ukuran 5,6 x 5 x 4.5 cm yang meluas hingga internal auditory canal dan didiagnosa sebagai tumor cerebro-pontine angle vestibular schwannoma sinistra. Pasien menjalani pembedahan dengan anestesi umum intubasi endotrakeal, posisi lateral kanan penuh, yang berlangsung selama 6 jam 40 menit. Target dari pengelolaan anestesi pada tindakan pembedahan tumor vestibular schwannoma adalah memfasilitasi lapangan pembedahan yang ideal dan melakukan proteksi serebral untuk mencegah cedera sekunder dengan mempertahankan tekanan perfusi serebral, menghindari instabilitas hemodinamik, memungkinkan dilakukannya pemantauan neurologi intraoperatif, deteksi dini dan pengelolaan segera bila terjadi komplikasi pembedahan.Anesthesia Management of Cerebello-pontine Angle Tumor Vestibular Schwannoma Resection in Lateral PositionAbstractCerebellopontine angle (CPA) tumors are the most common neoplasms in the posterior fossa, accounting for 5-10% of intracranial tumors. Most CPA tumors are benign, with over 85% being vestibular schwannoma (acoustic neuromas). The preferred treatment for symptomatic vestibular schwannoma has been surgical excision. Craniotomy for vestibular schwannoma resections in lateral position gave better surgical field exposure, but also posed increased risk of ventilation-perfusion mismatch and atelectasis of the dependent lung in lengthy surgery. A 25 years old woman, with loss of hearing function, disturbed sense of balance, left hemiplegia, difficulties to swallow, on magnetic resonance imaging (MRI) examination had solid lesion in the cerebello-pontine angle size 5,6 cm x 5 cm x 4.5 cm which is diagnosed as Cerebello-pontine angle vestibular schwannoma sinistra. Patient underwent surgical resection in right lateral position under general anesthesia and the surgical resection performed in 6 hour 40 minutes. The goals of anesthetic management in vestibular schwannoma tumor resection are to facilitate ideal surgical condition and provide brain protection by maintaining cerebral perfusion pressure, avoid hemodynamic instability, enable intraoperative neuro-monitoring and ensure the early detection and prompt management of potential complications.
Pencegahan dan Pengobatan Disfungsi Kognitif setelah Cedera Otak Traumatik Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2530.905 KB) | DOI: 10.24244/jni.vol3i1.130

Abstract

Kognisi adalah proses untuk mengetahui atau berpikir, memilih, mengerti, mengingat, dan menggunakan informasi. Gangguan kognitif adalah gangguan dalam melakukan perhatian dan konsentrasi, proses dan mengerti informasi, ingatan, komunikasi, perencanaan, organisasi, pemikiran, pemecahan masalah dan pengambilan keputusan, mengendalikan rangsangan dan hasrat. Lebih dari 50.000 orang meninggal setiap tahun akibat cedera otak traumatik (COT) dan 70.00090.000 mengalami kecatatan permanen di USA. Walaupun pasien dengan COT sedang, secara fisik mengalami pemulihan penuh, tapi sering mengalami perubahan tingkah laku jangka lama yang mempengaruhi pekerjaan, cara hidup, dan keluarganya. Setelah COT yang lebih berat, gangguan kognitif merupakan masalah paling umum dan memberikan kontribusi lebih daripada gangguan fisik. Luasnya defisit kognitif ditunjukkan oleh 1) beratnya diffuse axonal injury (DAI) yang ditunjukkan lamanya posttraumatic amnesia (PTA), luasnya atropi umum, dan 2) lokasi, dalamnya, dan volume lesi serebral fokal. Terapi difokuskan pada rehabilitasi neurokognisi. Sampai saat ini tidak ada terapi untuk cedera otak primer dan terapi yang dilakukan adalah mengurangi cedera sekunder yang dipicu oleh cedera primer. Jadi secara umum tetap menggunakan ABCDE neuroanestesi/neuroresusitasi dan secara khusus dengan pemberian infus lidokain, natrium laktat hipertonik, obat kholinergic, catecholaminergic, tricyclic antidepressants.Prevention and Management of Cognitive Dysfunction after TBICognition is the act of knowing or thinking process. It includes the ability to choose, understand, remember and use information. Cognition function disorder includes disturbances in accessing and optimizing attention and concentration, processing and understanding information, memory, communication, planning, organizing, and assembling, reasoning, problem-solving, decision-making, and judgment, controlling impulses, desires and being patient. More than 50,000 people die from traumatic brain injury (TBI) each year and other 70,00090,000 people are permanently disabled in the US. Even individuals with moderate head injuries who appear to be physically fully recovered, often have long lasting behavioral sequelae, which in turn affects the individuals occupation, lifestyle and interaction with family members. After a more severe injury, cognitive function disorder is considered more common compared to physical impairment. The extent of cognitive function deficit after TBI is reflected by a number of factors 1) the severity of diffuse axonal injury, as indicated by the length of post traumatic amnesia (PTA), the extent of generalized atrophy; and 2) the location, depth, and volume of focal cerebral lesions. Therapy is focused to neuro cognitive rehabilitation. Until now, there is no specific therapy for primary brain injury and commonly applied therapy is focused on reducing secondary brain injury. In general, the ABCDE of neuroanesthesia/neuroresuscitation is still commonly used, and in specific case, the need to administration of lidocaine infusion, sodium lactate hyperosmolar, cholinergic, catecholaminergic, and tricyclic antidepressants.
Pengaruh Gangguan Tidur dan Peranan Sitokin terhadap Luaran Stroke Iskemik Djajasasmita, Daswara
Jurnal Neuroanestesi Indonesia Vol 10, No 1 (2021)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2706.796 KB) | DOI: 10.24244/jni.v10i1.336

Abstract

Stroke merupakan penyebab kematian kedua di dunia. Sebanyak 15,4% dari seluruh kematian di Indonesia disebabkan oleh stroke. Prevalensi penyakit stroke meningkat dari tahun ke tahun dan akan menimbulkan masalah di bidang kesehatan. Salah satu faktor yang dapat memperburuk penyakit stroke, diantaranya adalah gangguan tidur. Tujuan penulisan artikel ini adalah untuk mengetahui hubungan antara gangguan tidur dan pengaruh sitokin terhadap luaran stroke iskemik. Stroke iskemik akibat aterosklerotik dengan adanya hipoksia pada neuron akan memicu pelepasan sitokin, termasuk tumor necrosis factor-alpha (TNF-?) dan interleukin-10 (IL-10) dari neuron dan sel glial. Sitokin juga berpengaruh terhadap pola tidur seperti nerve growth factor (NGF) menginduksi non-rapid eye movement sleep (NREM) dan rapid eye movement sleep (REM). Gangguan tidur terutama sleep apnea mempunyai risiko yang lebih besar terhadap kejadian stroke atau risiko kematian oleh sebab apapun. Proses yang terjadi pada stroke iskemik akut menimbulkan respon inflamasi, proses inflamasi ini seperti pedang bermata dua karena di satu sisi menimbulkan kerusakan yang lebih luas, namun di sisi lain dapat bertindak membantu perbaikan. Peningkatan produksi sitokin seperti interleukin-10 (IL-10), IL-6, dan C-reactive protein (CRP) akan menimbulkan luaran yang buruk pada penderita stroke.The Effect of Sleep Disturbances and The Role of Cytokines on The Outcome of StrokeAbstractStroke is the second cause of death in the world. As many as 15.4% of all deaths in Indonesia are caused by strokes. The prevalence of stroke increases from year to year and will cause problems in the health sector. One of the factors can exacerbate stroke, including sleep disturbances. The aim of this article is to examine the relationship between sleep disturbances and the effect of cytokines on ischemic stroke outcome. Ischemic stroke due to atherosclerosis in the presence of hypoxia in neuron will result in the release of cytokines, including tumor necrosis factor-alpha (TNF-?) and interleukin-10 (IL-10) from neurons and glial cells. Cytokines also influence sleep patterns such as nerve growth factor (NGF) inducing non-rapid eye movement sleep (NREM) and rapid eye movement sleep (REM). Sleep disorders, especially sleep apnea, have a greater risk of stroke or risk of death for any cause. The process that occurs in acute ischemic stroke causes an inflammatory response, this inflammatory process is like a double-edged sword because on the one hand it causes more extensive damage, but on the other hand it can act help repair. Increased production of cytokines such as interleukin-10 (IL-10), IL-6, and C-reactive protein (CRP) will lead to poor outcomein stroke patients.
Angka Morbiditas Pascaoperasi Tulang Belakang akibat Posisi Prone di Rumah Sakit Dr. Hasan Sadikin Bandung Periode November 2015Desember 2016 Nugraha, Ade Aria; Sudjud, Reza Widianto; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (240.536 KB) | DOI: 10.24244/jni.vol6i3.51

Abstract

Latar Belakang dan Tujuan: Operasi tulang belakang mengalami peningkatan secara signifikan selama dekade terakhir. Posisi prone dibutuhkan sebagai akses pada operasi tulang belakang melalui pendekatan posterior. Operasi tulang belakang dengan posisi prone memiliki risiko terjadi cedera yang dapat menyebabkan morbiditas serius.Tujuan penelitian ini adalah untuk mengetahui angka morbiditas pascaoperasi tulang belakang dengan posisi prone di Rumah Sakit Dr. Hasan Sadikin Bandung.Subjek dan Metode: Metode penelitian ini adalah deskriptif observasional dengan rancangan potong lintang pada pasien yang dirawat di Rumah Sakit Dr. Hasan Sadikin Bandung dan menjalani operasi tulang belakang dengan posisi prone dari bulan November 2015 sampai dengan bulan Desember 2016.Hasil: Hasil penelitian ini dari 99 subjek penelitian diperoleh 8 kasus (8,1%) cedera penekanan, 1 kasus (1%) cedera mata, dan 1 kasus (1%) cedera pada saraf tepi. Perubahan fisiologi dan efek penekanan akibat posisi prone serta keadaan selama operasi memengaruhi terjadinya morbiditas pada pasien yang menjalani operasi tulang belakang.Simpulan: Kesimpulan dari penelitian ini adalah angka morbiditas pascaoperasi tulang belakang akibat posisi prone di Rumah Sakit Dr. Hasan Sadikin Bandung periode November 2015Desember 2016 sebanyak 10 kasus (10%).The Incidence of Patients Morbidity After Spinal Surgery with Prone Position in Dr. Hasan Sadikin General Hospital During November 2015December 2016Background and Objective: The rate of spine surgeries has increased significantly over the past decade. Prone position is required as an access to spinal surgery through the posterior approach. Spinal surgery with prone surgery poses a risk of injury that can lead to serious morbidity. The purpose of this study was to determine the number of postoperative morbidity of the spine due to prone position in Dr. Hasan Sadikin Hospital Bandung Subjects and Methods: The methods of this research is descriptive observational with cross sectional design and subjects of this study is patient undergo spine surgery in prone position in Dr. Hasan Sadikin Hospital Bandung period November 2015 ? December 2016. Results: Results of this study had shown that among 99 subjects, 8 cases (8.1%) were diagnosed with pressure ulcer, 1 case (1%) with eye injury, and 1 case (1%) with peripheral nerve injury. The physiological changes in a prone position, pressure effect and conditions during surgery might lead to morbidity in patients undergoing spinal surgery.Conclusion: The conclusion of this study is the rate of postoperative morbidity of the spine due to prone position in Dr. Hasan Sadikin Hospital Bandung period November 2015December 2016 as many as 10 cases (10%).
Penatalaksanaan Anestesi Pada Shaken Baby Syndrome Mafiana, Rose; Saleh, Siti Chasnak; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 4 (2012)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (262.873 KB) | DOI: 10.24244/jni.vol1i4.183

Abstract

Shaken Baby Syndrom adalah suatu kondisi perdarahan intraserebral atau intraokuler tanpa atau dengan hanya minimal trauma pada kepala, leher atau wajah. Kasus ini sering disebut kasus kekerasan anak- orang tua. Jumlah kejadian ini cukup banyak terjadi di US, sekitar 50.000 kasus pertahun, sepertiganya meninggal dunia dan setengah dari kasus yang bertahan hidup mengalami defisit neurologis yang berat. Umumnya prognosa penderita buruk. Di Indonesia sendiri data mengenai hal ini belum ada. Tapi mempunyai kecenderungan untuk meningkat.Gejala yang sering didapat adalah hematom subdural, perdarahan retina dan edema otak. Sering diikuti juga dengan multipel fraktur, trauma cervical dan jaringan leher lainnya. Peneliti lain melaporkan banyaknya kasus Diffuse Axonal Injury (DAI) pada kasus ini. Penanganan neuroanestesinya secara umum sama dengan neuroanestesi cedera otak traumatika pada pediatrik, karena terjadi peningkatan ICP sehingga mempengaruhi CBF, CMRO2 dan autoregulasi otak. Obat, tehnik anestesi yang digunakan dan perhitungan cairan selama operasi diusahakan tidak memperburuk keadaan . Pasca operasi penderita dirawat dan diobservasi di PICU.Anesthesia Management For Shaken Baby SyndromeShaken Baby Syndrome is a condition of intracerebral hemorrhage or intraocular without or with only minimal trauma to the head, neck or face. This case is often referred to cases of child-parent violence. This cases in the U.S, approximately 50,000 cases per year. From all event, one third died and half of the cases that survive with severe neurological deficit. Generally, prognosis of patients is poor. In Indonesia data on this subject does not exist. But it has a tendency to increase. Symptoms of a subdural hematoma is often obtained, retinal hemorrhages and brain edema.This case often followed by multiple fractures, cervical and other neck trauma tissues. Diffuse axonal injury researchers often reported for this case. Generally neuroanestesi technique for pediatric equal with pediatric trauma neuroanesthesia. Anesthesi challenges for this case was ICP, because increased ICP could influence for CBF, CMRO2 and cerebral autoregulation. Avoid anesthesi drugs , technique and the calculation of fluid during surgery to damaged this condition. Postoperative patients were treated and observed in the PICU.

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