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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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Pengelolaan Kadar Gula Darah Perioperatif pada Pasien Diabetes Mellitus dengan Tumor Cerebellopontine Angle Santosa, Dhania Anindita; Gaus, Syafruddin; Oetoro, Bambang J.; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (405.746 KB) | DOI: 10.24244/jni.vol7i1.25

Abstract

Prevalensi penyakit diabetes mellitus (DM) meningkat sangat cepat pada abad ke-21, terutama karena obesitas, penuaan dan kurangnya aktivitas fisik. International Diabetes Federation (IDF) menyatakan diperkirakan penderita DM menjadi 380 juta pada tahun 2025. Pasien dengan DM yang menjalani pembedahan mungkin sudah disertai dengan penyakit lain akibat DM. Episode hipoglikemia, hiperglikemia dan variabilitas kadar gula darah yang tinggi perioperatif memberikan risiko tingginya komplikasi perioperatif pada pasien. Seorang ahli anestesi memegang peranan penting dalam pengelolaan perioperatif pasien-pasien seperti ini, terutama pasien bedah saraf di mana otak sangat bergantung pada glukosa sebagai bahan bakar. Seorang wanita usia 46 tahun dengan DM dan tumor cerebellopontine angle (CPA) menjalani pembedahan elektif eksisi tumor. Pembedahan dilakukan dengan anestesi umum intubasi endotrakeal dan berjalan kurang lebih sembilan jam. Tantangan selama periode perioperatif adalah menjaga kadar gula darah tetap dalam rentang target yang diinginkan untuk meminimalisir cedera sekunder pada otak yang dapat mempengaruhi luaran kognitif serta komplikasi perioperatif yang mungkin terjadi. Pascabedah pasien dirawat di ICU dengan bantuan ventilator dan dilakukan ekstubasi tiga jam pascabedah dengan kadar gula darah stabil dan tanpa sequelaePerioperative Glucose Control in Diabetic Patients with Cerebellopontine Angle TumorPrevalence of patients with diabetes mellitus (DM) increases rapidly in the 21st century, mainly due to obesity, aging and lack of physical activity. International Diabetes Federation (IDF) predicted that by the year of 2025, 380 million people will suffer from DM. Diabetic patients undergoing surgery might have other diseases caused by DM. Episodes of hypoglycemia, hyperglycemia and high perioperative glucose level put the patients into higher perioperative risks. Anesthesiologists play a key role in perioperative management in these patients, moreover in neurosurgery pastients, as brain is very glucose-dependent. A 46 year old diabetic woman with cerebellopontine angle (CPA) tumor underwent elective surgery of tumor removal. Surgery was done under general endotracheal anesthesia and lasted for nine hours. Challenges during perioperative period are to maintain glucose level within target range to minimize secondary injury to the brain which may influence cognitive outcome and other possible perioperative complications. Patient was taken care at the ICU post operatively with ventilator. Patient was weaned and extubated three hours later with stable glucose control and no sequelae.
Pemantauan Neurofisiologis Intraoperatif selama Anestesia untuk Operasi Meningioma Foramen Magnum Firdaus, Riyadh; Suryono, Bambang; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2498.525 KB) | DOI: 10.24244/jni.vol3i3.149

Abstract

Pemantauan neurofisiologis intraoperatif (Intraoperative neurophysiological monitoring/IONM) pada operasi yang rentan mencederai saraf sangat penting untuk menunjang proses keputusan medis intraoperatif dan pada akhirnya mengurangi angka morbiditas. Operasi meningioma foramen magnum sangat berisiko cedera saraf dan morbiditas sehingga menjadi kandidat yang cocok untuk penggunaan IONM. Cakupan manajemen anesthesia pada operasi yang menggunakan IONM adalah pertimbangan tentang pilihan dan dosis obat anestesia yang digunakan serta perhatian terhadap kestabilan homeostasis pasien. Pemahaman yang baik oleh dokter bedah, anestesi dan neurologi akan membuat tindakan operasi berjalan dengan lancar dan mencegah terjadinya komplikasi intra dan pascaoperasi. Seorang wanita umur 39 tahun dengan keluhan utama nyeri kepala belakang sejak 2 bulan yang lalu. Berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang pasien di diagnosis tumor meningioma pada regio foramen magnum. Pasien dilakukan operasi kraniotomi removal tumor dengan panduan IONM dalam posisi park bench. Lama operasi kurang lebih 14 jam. Pascaoperasi pasien tidak dilakukan ekstubasi dan dirawat di ICU sehari.Intraoperative Neurophysiological Monitoring (IONM) during Anesthesia for Meningioma Foramen Magnum SurgeryIntraoperative neurophysiological monitoring (IONM) in a surgery that is prone to neuronal injury is very useful to guide intraoperative decision makings and to reduce morbidity. Foramen magnum tumor surgerycarries a very high risk for neuronal injury, and thereforeapplication of IONM would be advantageous. The termsof anesthetic management in IONM-guided-surgery are the selection of anesthetic agents with limitation of the dosageswhileremain focusingon stability of patients homeostasis. A thorough understanding and communication among surgeon, neurologist and anesthesiologist are important to createan uneventful procedure and to reduce intra and postoperative complications.A 39 years old female with severe headache for 2 months was diagnosed with meningioma at foramen magnum based on history, physical examination, and advanced examination procedures. The patient was underwent tumor removal guided by IONM on park bench position. The duration of surgery was 14 hours. The patient was not extubatedpostoperatively and admitted to ICU for a day.
Perbandingan Luaran Klinis pada Pasien Stroke Iskemik Fase Akut dengan Satu atau Lebih Faktor Risiko Hidayat, Faqih; Gamayani, Uni; Wibisono, Yusuf; Berliana, Sobaryati; Amalia, Lisda
Jurnal Neuroanestesi Indonesia Vol 11, No 1 (2022)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2322.326 KB) | DOI: 10.24244/jni.v11i1.345

Abstract

Latar Belakang dan Tujuan: Stroke menurut WHO adalah terjadinya gejala penurunan fungsi neurologis secara tiba-tiba, fokal maupun global, berlangsung lebih dari 24 jam karena gangguan pasokan darah menuju ke otak. Stroke merupakan penyakit multifaktorial penyebab kematian dan disabilitas. Sebagian besar pasien stroke memiliki ? 2 faktor risiko. Tujuan penelitian ini adalah untuk membandingkan gambaran luaran klinis pada pasien stroke iskemik fase akut dengan satu atau lebih faktor risiko.Subjek dan Metode: Penelitian ini merupakan penelitian deskriptif retrospektif pada pasien stroke iskemik fase akut serangan pertama di Departemen Neurologi Rumah Sakit Hasan Sadikin Bandung periode 20152019.Hasil: Terdapat 176 subjek pada penelitian ini, 160 pasien (90,9%) dengan lebih dari satu faktor risiko dan 16 pasien (9,1%) dengan satu jenis faktor risiko. Faktor risiko paling banyak adalah hipertensi sebanyak 147 pasien (83,5%), dislipidemia 91 pasien (51,7%) dan penyakit kardiovaskular 56 orang (31,8%). Penelitian menunjukan luaran klinis yang diukur dengan skor National Institute of Health Stroke Scale (NIHSS) keluar RS pada kelompok lebih dari satu faktor risiko lebih bervariatif dari derajat ringan hingga sangat berat. Sedangkan, pada kelompok dengan satu faktor risiko skor NIHSS cenderung ringan hingga sedang.Simpulan: Pasien dengan lebih dari satu faktor risiko memiliki luaran klinis lebih buruk dibandingan pasien dengan satu faktor risiko.Comparison of The Clinical Outcomes between Single and Multiple Risk Factors in Acute Phase Ischemic Stroke PatientsAbstractBackground and Objective: Stroke according to WHO is a sudden symptom of neurological deficit, focal or global, lasting 24 hours due to disruption of blood supply to the brain. Stroke is a multifactorial disease that causes death and disbility. Most of stroke patients have ?2 risk factors. The aim of this study was to determine the comparison of clinical outcomes between single and multiple risk factor in acute phase ischemic stroke patients.Subjects and Methods: This study was retrospective descriptive study in patient with acute phase ischemic stroke in the Neurology Department Hasan Sadikin Hospital Bandung from 2015-2019.Results: There were 176 subjects in this study, 160 patients (90.9%) with multiple risk factor and 16 patients (9.1%) with single risk factor. The most common risk factors were hypertension in 147 patients (83.5%), dyslipidemia in 91 patients (51.7%) and cardiovascular disease in 56 pasien (31.8%). The study showed that the clinical outcomes as measured by National Institute of Health Stroke Scale (NIHSS) score for hospital discharge in multiple risk factors group varied from mild to very severe. Meanwhile, single risk factor groups the score tends to be mild to moderate.Conclusion: Multiple risk factor patients had a worse clinical outcome than single risk factor patients.
Insidensi Tumor Supratentorial berdasarkan Jenis dan Letaknya di RSUP Dr. Hasan Sadikin Tahun 20122013 M, Mutivanya Inez; Bisri, Dewi Yulianti; Adam, Achmad
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2067.807 KB) | DOI: 10.24244/jni.vol4i3.126

Abstract

Latar Belakang dan Tujuan: Tumor otak adalah kumpulan sel tidak normal pada otak yang bermultiplikasi dan dapat menyebabkan kerusakan pada jaringan sekitarnya dan organ-organ terkait. Tumor supratentorial adalah tumor otak yang terletak superior terhadap tentorium serebeli. Tentorium serebeli adalah lapisan dural yang memisahkan lobus oksipital pada otak besar dengan otak kecil. Tumor supratentorial adalah 33% dari total tumor otak. Penelitian ini bertujuan untuk menggambarkan angka kejadian tumor supratentorial berdasarkan jenis dan letak tumor.Subjek dan Metode: Objek penelitian adalah rekam medis pasien dengan diagnosis tumor supratentorial yang masuk ke Rumah Sakit Hasan Sadikin Bandung pada Januari 2012 hingga Desember 2013. Penelitian ini merupakan penelitian deskriptif memakai rancangan studi kasus. Data dibagi kedalam kelompok sesuai dengan jenis dan letak tumor kemudian dilihat karakteristiknya.Hasil: Terdapat 494 pasien tumor supratentorial tapi hanya ada 168 yang memiliki informasi lengkap. Berdasarkan jenisnya, tumor dikelompokkan secara garis besar menjadi glioma (14,88%), tumor kranial dan paraspinal (0,60%), tumor meningen (70,24%), tumor pada region sella (10,12%) dan tumor metastasis (4,17%). Berdasarkan letaknya, secara garis besar tumor terletak di sisi kanan (35,12%), sisi kiri (36,90%), region sellar (13,69%), sisi tengah (4,16%) dan bilateral (10,12%)Simpulan: Jenis tumor supratentorial terbanyak adalah meningioma dan lokasi tumor supratentorial paling banyak adalah pada sisi kiri otak secara umum, atau pada lobus frontal secara spesifik.Incidence of Supratentorial Tumor based on Types and Locations of Tumor in Hasan Sadikin Hospital Year 20122013Background and Objective: Brain tumor is a group of abnormal cells in the brain which multiplies and causes damage to the surrounding tissues and related organs. Supratentorial tumor is a brain tumor which is located at superior of tentorium cerebelli. Tentorium cerebelli is the dural layer which separates the occipital lobe of cerebrum with the cerebellum. Thirty three percent of brain tumor is supratentorial tumor. This study was aimed to observe the prevalence of supratentorial tumor based on the type and location of the tumor.Subject and Method: The objects of the study were the medical records of patients diagnosed with supratentorial tumor whom admitted to Dr. Hasan Sadikin General Hospital Bandung from January 2012 until December 2013. This study was a case- descriptive study and data was divided into groups based on type and location of the tumor and then analyzed based on the characteristics.Result: There were 494 patients with supra tentarial tumor, but only 168 patients had complete infomation. Based on the type, tumors were categorized generally into glioma (14.88%), cranial and paraspinal tumor (0.60%), meningeal tumor (70.24%), sellar region tumor (10.12%) and metastatic tumor (4.17%). Based on the location in the brain, tumors were located generally in the right side (35.12%), left side (36.90%), sellar region (13.69%), middle (4.16%) and bilateral (10.12%).Conclusion: The most common type of supratentorial tumor is meningioma and most common location of supratentorial tumor is in the left side of the brain, particularly in the frontal lobe.
Manajemen Perioperatif Gejala Ekstrapiramidal (EPS) pada Hidrocephalus Tekanan Normal (NPH) Lestari, Ni Putu Dharmi; Suyasa, Agus Baratha
Jurnal Neuroanestesi Indonesia Vol 9, No 3 (2020)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2819.104 KB) | DOI: 10.24244/jni.v9i3.291

Abstract

Gejala ekstrapiramidal (EPS) merupakan gangguan gerak akibat efek samping obat penghambat reseptor dopamin. Gejala-gejala EPS antara lain dystonia, akathisia, dan parkinson. Gejala EPS pada kasus ini ditemukan pada hidrocephalus tekanan normal (NPH) yang tidak mengkonsumsi obat penghambat reseptor dopamin. Hidrocephalus tekanan normal adalah hidrocephalus yang tidak bersamaan dengan peninggian tekanan intrakranial (TIK). Melaporkan kasus laki-laki 57 tahun dengan penurunan kesadaran dan gejala ekstrapiramidal serta Normo pressure hydrocephalus (NPH), dilakukan operasi VP Shunt. Operasi dilakukan dengan anestesi umum, menggunakan ETT no 7,5 non kinking, ventilasi kendali. Premedikasi diberikan midazolam 2 mg iv, Co induksi dengan oxycodon 10 mg iv. Induksi dengan propofol 150 mg iv, fasilitas intubasi dengan rokuronium 30 mg iv, pemeliharaan dengan O2 : Air (50 : 50), sevofluran, propofol kontinyu 100 mg/jam, rokuronium 20 mg/jam.Hemodinamik stabil, TDS 130150 mmHg, TDD 8090 mmHg, HR 5070 x/menit, saturasi O2 99100%, etCO2 3537. Pasca operasi pasien dirawat di ruang intensif (ICU) untuk pemantauan tekanan darah dan gejala ekstrapiramidal. Tujuan utama penanganan seharusnya tidak semata-mata untuk penanganan gejala akut EPS namun juga penanganan penyakit dasar penyebab EPS terkait morbiditas serta menjaga kualitas hidup. Manajemen multidisiplin (bedah saraf, saraf, anestesi intensif dan rehabilitasi medis) dibutuhkan untuk hasil jangka panjang yang lebih baik.Perioperative Management Extrapyramidal Symptoms (EPS) in Normo Pressure Hydrocephalus (NPH)AbstractExtrapyramidal symptoms (EPS) are movement disorders due to side effects of dopamine receptor blocking agents. Symptoms of EPS include dystonia, akathisia, and parkinsonism. Symptoms of EPS in this case are found in normal pressure hydrocephalus (NPH) which does not consume dopamine receptor blocking drugs. Normal pressure hydrocephalus is hydrocephalus which does not coincide with intracranial pressure (ICT) elevation. Reported a case of a 57-year-old male with decreased consciousness and extrapyramidal symptoms and Normo pressure hydrocephalus (NPH), a V-P Shunt operation was performed. The operation was carried out under general anesthesia, using a non-kinking ETT no. 7.5, controlled ventilation. Premedication given midazolam 2 mg iv, Co induction with oxycodon 10 mg iv. Induction with propofol 150 mg iv, intubation facilities with rocketuronium 30 mg iv, maintenance with O2: Air (50: 50), sevoflurane, propofol continuous 100 mg/hour, rokuronium 20 mg/hour. Stable hemodynamics, SBP 130150 mmHg, DBP 8090 mmHg, HR 5070 x/min, O2 saturation 99100%, etCO2 3537. After surgery the patient was treated in the intensive care unit (ICU) for monitoring blood pressure and extrapyramidal symptoms. The main goal of treatment should not be solely for the treatment of acute symptoms of EPS but also for the management of basic disease causing EPS related to morbidity and maintaining quality of life. Multidisciplinary management (neurosurgery, neurosurgery, intensive anesthesia and medical rehabilitation) are needed for better long-term results.
Keberhasilan Resuitasi Jantung Paru Otak (RJPO) dengan Posisi Telungkup pada Pada Pasien Pediatrik saat Pengangkatan Tumor Infratentorial Satriyanto, M. Dwi; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 1 (2012)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1591.587 KB) | DOI: 10.24244/jni.vol1i1.84

Abstract

Tumor infratentorial merupakan tumor yang paling sering ditemukan pada anak-anak dengan gejala klinis antara lain ataksia, kelainan saraf kranial, muntah, sakit kepala, penurunan kesadaran, dan hidrosefalus. Umumnya tumor infratentorial memerlukan tindakan bedah. Kasus seorang anak laki-laki 3 tahun dengan tumor infratentorial yang mendesak ventrikel IV, dilakukan tindakan craniotomy tumor removal dengan posisi telungkup. Saat tumor diangkat terjadi perdarahan dan menyebabkan perubahan hemodinamik sampai henti jantung yang berlangsung sangat cepat, kemudian operasi dan seluruh obat anestesi dihentikan, dilakukan Resusitasi Jantung Paru Otak (RJPO) dalam posisi telungkup dengan pemberian obat resusitasi (adrenalin dan sulfas atropin), dan melakukan pengisian intravaskuler volume (pemberian cairan dan darah), setelah dilakukan RJPO selama 10 menit hemodinamik kembali stabil. Tindakan operasi dilanjutkan untuk menutup luka operasi. Post operasi pasien di rawat di ICU dengan ventilasi mekanik (propofol dan vecuronium kontinu), pada hari ke 3 dilakukan operasi kembali untuk menyempurnakan operasi yang telah dilakukan. Post operasi pasien dirawat kembali di ICU, selama perawatan hemodinamik stabil, hari ke 4 pasien sadar dengan sequele motorik pada sisi tubuh sebelah kiri. Pada operasi pengangkatan tumor infratentorial, salah satu risiko yang dapat terjadi yaitu perdarahan masif selama operasi yang dapat mempengaruhi hemodinamik. Diperlukan persiapan dan pengawasan ketat selama operasi. Pada kasus ini, RJPO tetap dapat dilakukan pada posisi yang terbatas (posisi telungkup).Successfully of Cardio Pulmonary Cerbral Resuscitation (CPCR) in Prone Position on Pediatric Patient during Infratentorial Tumor SurgeryInfratentorial tumor is more frequent in children, with sign and symptom of ataxia, cranial nerve disorder, vomiting, headache, decrease of consciousness level and hydrocephalus. Infratentorial tumor usually requires surgical removal. Case report of a 3 year old boy with infratentorial tumor, which depressed the 4th ventricle, undergone craniotomy tumor removal with prone position. When tumor was removed, massive bleeding occurred and caused sudden change in hemodynamic and cardiac arrest. The operation and anesthetic agents were discontinued, followed by Cardio Pulmonary Cerebral Resuscitation (CPCR) in prone position with resuscitation drugs (i.e adrenalin and sulfas atropin), as well as blood and fluids to replace the intravascular volume. After approximately 10 minutes of CPCR, hemodynamic was stable. Operation was continued to close operation wound. Post operation, patient was admitted to ICU and being treated with mechanical ventilation under sedation with continues propofol and vecuronium. On the 3rd day, re-operation was conducted to establish the previous operation as planned. The patient was admitted to the ICU post operatively. During management in ICU, hemodynamic was stable and the patient woke up on the 4th day with motoric squele on his left body side. In conducting an infratentorial tumor removal, an anesthesiologist should be aware for the risk of massive bleeding durante operation which could manipulate hemodynamic. There for special preparation and tight monitoring are required during the operation. In this case, CPCR can be done in limited position (prone position).
Pengelolaan Anestesi untuk Cedera Otak Traumatik pada Pasien dengan Stroke Iskemik Nency Martaria; Iwan Abdul Rachman; MM. Rudi Prihatno
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2974.56 KB) | DOI: 10.24244/jni.v8i3.235

Abstract

Cedera otak traumatik (COT) merupakan salah satu penyebab utama kematian dan disabilitas di seluruh dunia. Kelompok yang paling berisiko mengalami COT adalah pasien geriatrik, dimana mayoritas disebabkan oleh jatuh. Kejadian jatuh salah satunya dikaitkan dengan hemiparesis akibat riwayat stroke. Seorang laki-laki, 68 tahun dengan Glasgow Coma Scale (GCS) M3V1E4. Pasien mengalami cedera kepala akibat jatuh ketika naik tangga. Pasien memiliki riwayat gangguan keseimbangan akibat stroke iskemik dan mendapatkan terapi clopidogrel. Hasil pemeriksaan CT scan memperlihatkan adanya perdarahan akut sub dural dengan penyimpangan garis tengah 0,9 cm. Operasi pertama yang dilakukan adalah kraniektomi dekompresi dan pemasangan kasa untuk kontrol perdarahan. Perdarahan baru ketika operasi, timbul di midparietal kanan dan diduga berasal dari vena penghubung yang dekat dengan sinus. Perdarahan sulit dihentikan dengan total perdarahan 2500 cc. Tanda vital selama operasi stabil dengan topangan norepinefrin 0,2 mcg/kg/menit. Anestesi dengan menggunakan fentanyl 200 mcg, propofol 100 mg dan vecuronium berkelanjutan. Pemeliharaan dengan oksigen, compressed air dan sevofluran 2%. Pasien ditransfusi pack red cel (PRC) 700 ml. Setelah delapan hari perawatan ICU, kadar fibrinogen dan hemoglobin menjadi normal,dilakukan pengangkatan kassa dari dalam kepala pasien. Saat ini pasien telah dipulangkan dari rumah sakit dengan Glasgow Outcome Scale 3 dan hemiparese sinistra. Pengelolaan anestesi pada operasi pasien memperhatikan kondisi otak akibat COT, stroke iskemik dan efek dari terapi Clopidogrel pada operasi cito. Brain Trauma Foundation memberikan panduan untuk pengelolaan COT yang bertujuan untuk memberikan luaran yang lebih baik. Anesthetic Management for Traumatic Brain Injury in Patient with Ischemic StrokeAbstractTraumatic brain injury (TBI) is one of the leading cause of death and disability around the world. Geriatric being the most vulnerable group, mainly because of falling, of which associated with hemiparesis following stroke. A 68 years old man with Glaslow Coma Scale (GCS) M3V1E4 had brain injury after falling from stairs. The patient is having balance disorder following stroke and receiving clopidogrel afterwards. CT-scan showed acute subdural hemorrhage (SDH) with 0.9cm midline shift. Decompression craniectomy and gauze insertion to stop the bleeding was done on the first surgery. New onset of bleeding occurred in right midparietal. Bleeding was uncontrollable with total volume of 2500cc. Vital signs remained stable with norepinephrine 0.2mcg/kg/min. Anesthesia under fentanyl 200 mcg, propofol 100mg, and continuous vecuronium. Patient was transfused with pack red cel (PRC) total of 700 cc. After eight days in ICU, fibrinogen and hemoglobin returned to normal level, therefore the patient undergone gauze removal. The patient discharged with GOS 3 and left hemiparesis. Anesthesia management in this patient’ surgery focused on brain condition following TBI, ischemic stroke and the effect of clopidogrel therapy in emergency operation. Brain Trauma Foundation issued a management guideline of TBI for better outcome.
Kadar Hemoglobin, Jumlah Perdarahan dan Transfusi pada Pasien yang Menjalani Operasi Tumor Otak di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung Tahun 20152016 Ningsih, Diana Fitria; Suwarman, Suwarman; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (263.852 KB) | DOI: 10.24244/jni.vol7i2.4

Abstract

Latar Belakang dan Tujuan: Operasi tumor otak berhubungan erat dengan risiko perdarahan dalam jumlah besar yang dapat menyebabkan anemia. Efek klinis anemia dapat diperbaiki dengan pemberian transfusi darah. Transfusi diberikan dengan target level Hemoglobin (Hb) antara 9 sampai 10 gr/dL. Tujuan penelitian ini adalah untuk mengetahui gambaran kadar Hb dan hematokrit prabedah dan pascabedah, jumlah perdarahan serta pemberian transfusi darah pada pasien yang menjalani operasi tumor otak di RSUP Dr. Hasan Sadikin Bandung periode Juni 2015 sampai dengan Juni 2016.Subjek dan Metode: Penelitian ini merupakan penelitian deskriptif observasional yang dilakukan secara retrospektif terhadap 126 objek penelitian yang diambil di bagian rekam medis.Hasil dan Simpulan: Penelitian ini memperoleh hasil kadar Hb prabedah rata-rata sebesar 13,231,35 gr/dL dan hematokrit prabedah rata-rata sebesar 39,193,54%. Kadar Hb pascabedah 9 gr/dL sebanyak 15 pasien, Hb 910 gr/dL sebanyak 6 pasien dan Hb 10 gr/dL sebanyak 105 pasien. Hematokrit pascabedah rata-rata sebesar 34,036,03%. Jumlah perdarahan rata-rata sebesar 11591032,66cc. Transfusi yang diberikan pada 56 pasien terdiri atas PRC dengan jumlah rata-rata sebesar 365,81258,70cc, FFP rata-rata sebesar 425,45274,78cc dan WB 250cc.Hemoglobin Levels, Blood Loss and Transfusionin Patients Underwent Brain Tumor Surgery atDr. Hasan Sadikin Bandung General Hospital During 20152016Background and Objective: Brain tumor surgery is closely related to the risk of numerous bleeding that can cause the patient to be in an anemic condition. The clinical effects of anemia can be improved by administered blood transfusions. Transfusion can be administered with target Hemoglobin (Hb) level between 9 to 10 gr/dL.The purpose of this study was to describe of preoperative and postoperative levels of Hb and hematocrit, blood loss and how blood transfusion administered in patients undergoing brain tumor surgery at Dr. Hasan Sadikin Bandung during June 2015 to June 2016.Subject and Method: This is a descriptive observational study with retrospective approach to 126 objects taken at medical records.Result and Conclusion: The average of preoperative Hb level was 13,231,350 gr/dL and the average of preoperative hematocrit level was 39,193,54%. Number of patients with postoperative Hb level 9 gr/dL were 15 patients, Hb 9-10 gr/dL were 6 patients and Hb10 gr/dL were 105 patients. The average of postoperative Ht were 34,036,032%. The rate of blood loss was 11591032,66cc. The rate of transfusions administered to 56 patients was pack red cell 365,81258,70cc, fresh frozen plasma 425,45274,78cc and whole blood 250cc.
Efek Anestesia Aliran Rendah Sevofluran terhadap Respon Inflamasi pada Susunan Saraf Pusat Harimin, Kusuma; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (618.996 KB) | DOI: 10.24244/jni.vol3i2.140

Abstract

Anestesi aliran rendah adalah teknik anestesi yang menggunakan aliran gas 1L/menit. Oleh karena adanya rebreathing, maka pada anestesi aliran rendah yang menggunakan sevofluran akan terjadi produk degradasi dengan CO2 absorber sehingga terbentuk senyawa A dan senyawa B. Senyawa A bersifat neprotoksik pada ginjal tikus, karena enzim ? liase 30 kali lebih aktif pada tikus dari pada manusia, sedangkan pada manusia tidak terbukti senyawa A berefek neprotoksik. Anestesia sevofluran dapat menimbulkan respons inflamasi yang diawali dengan pelepasan interleukin (IL)1 dan TNF?, kemudian menstimulasi IL6 yang sangat berperan pada respons fase akut. Akan terjadi interaksi antara sistem imun dengan sistem neuroendokrin, yang mana IL1 dan IL6 dapat menstimulasi adrenocorticotrophic hormone (ACTH) sehingga terjadi peningkatan pelepasan kortisol. Metabolit sevofluran dan senyawa A tidak dapat menembus sawar darah otak sehingga pengaruh negatif dari metabolit dan produk degradasi sevofluran terhadap otak tidak ada. Bahkan, melalui penelitian lebih lanjut, sevofluran diketahui mempunyai efek neuroproteksi.The Effect of Sevoflurane Low Flow Anesthesia to Inflammatory Response on Central Nervous SystemLow flow anesthetic is an anesthesia technique using gas flow less than 1 L/ min. Due to the rebreathing system, a low flow anaesthesia using sevoflurane will produce degradation products through reaction with the CO2 absorber which will form compound A and compound B. Compound A is nephrotoxic to rat kidney because the ? -lyase enzyme in rat is 30-fold more active than in human, and this compound has been proven to be not nephrotoxic in human. Sevoflurane can cause inflammatory response which started with the release of interleukin (IL)-1 and TNF-? followed by stimulation of IL-6, which plays important part in the acute phase. Interaction between the neuroendocrine and immune systems will occur where IL-1 and IL-6 cytokines will stimulate the production of adrenocorticotrophic hormone (ACTH), which in turn will increase the production of cortisol. Sevoflurane metabolites and compound A can not penetrate blood brain barrier, therefore, the negative effects of sevoflurane metabolites and degradation products to the brain does not happen. Further advanced studies even showed that sevoflurane has a neuroprotective effect.
Manajemen Low Flow Anesthesia pada Pasien Kraniosinostosis dengan Hipertelorisme yang menjalani Four Box Wall Osteotomy, dan Eksisi Redundant Skin Fronto Nasal Cahyadi, Arief; Bisri, Dewi Yulianti; Harahap, M Sofyan; Gaus, Syaruddin
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (558.236 KB) | DOI: 10.24244/jni.v10i3.391

Abstract

Kraniosinostosis merupakan kasus yang didagnosis di tahun pertama kehidupan dan dapat membutuhkan pembedahan pada usia muda. Kraniosinostosis merupakan salah satu bagian dari sindrom hipertelorisme dengan angka kejadian sebesar 20%. Anak laki laki 13 tahun dengan hipertelorisme yang sudah menjalani rangkaian operasi koreksi hipertelorisme sebelumnya. Pasien direncanakan operasi koreksi lanjutan berupa four box wall osteotomy yang merupakan koreksi bagian frontal berupa pelepasan kraniosinostosis di sutura koronal. Risiko perdarahan masif karena anak sudah besar serta operasi panjang menjadi penyulit. Tatalaksana jalan napas memerlukan modifikasi karena deformitas yang ada, penggunaan low flow anestesi untuk membantu menjaga suhu dan mengurangi penggunaan gas anestesi, manajemen cairan intraoperatif berupa kombinasi kebutuhan pemeliharaan dan penggantian perdarahan yang terjadi, serta tatalaksana nyeri pasca operasi pada anak menjadi pertimbangan lain. Penyulit covid-19 terjadi pada pasien sehingga membuat ekstubasi tertunda. Perdarahan masif memerlukan protokol transfusi masif untuk mendukung ketersediaan darah dalam waktu singkat. Produk darah PRC, FFP dan TC harus tersedia karena faktor koagulasi juga perlu diperhatikan. Manajemen anestesi pada hipertelorisme dengan tindakan four box wall osteotomy memerlukan kerja sama baik antara anestesi, bedah saraf, bedah plastik serta ICU anak untuk menurunkan risiko perioperatif termasuk kekhususan covid-19 di era pandemi.Low Flow Anesthesia Management Craniosynostosis Patient with Hypertelorism underwent Four Box Wall Osteotomy and Fronto Nasal Redundant Skin ExcisionAbstractCraniosynostosis is a case that diagnosed in the first year of life and can need surgical in young age. Craniosynostosis is a part of hypertelorism with incidence rate around 20%. Boy, 13 years old with hypertelorism had undergone multiple surgery for correction of hypertelorism before. Patient was planned to advance surgical correction of four box wall osteotomy which consist frontal part correction and part of it is release craniosynostosis in coronal suture. Risk of massive bleeding because patient already in teen age and length of surgery can be prolonged. Difficult airway management due to fascial deformity, use of low flow anesthesia to preserve temperature and reduce inhalation anesthesia usage, intraoperative fluid management in consideration maintenance and replacement blood loss and post operative pain management has become another consideration. Covid-19 as part of problems post operatively being known before extubation made the process is delayed. Massive bleeding needs massive transfusion protocol to speed up blood availability. Blood product such as PRC, FFP and TC should be available because coagulation factor is part of consideration. Anesthesia management in hypertelorism with four box wall osteotomy need good communication between anesthesiologist, neurosurgeon, plastic surgeon and pediatric intensivist to reduce perioperative risk including covid-19 in pandemic era.Key words: Low flow anesthesia management, craniosynostosis, hypertelorism, four box wall osteotomy

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