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All Journal Jurnal Neuroanestesi Indonesia
A. Hmendra Wargahadibrata
Faculty of Medicine Universitas Padjadjaran Bandung
Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

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Pengelolaan Perioperatif Cedera Medula Spinalis Servikal karena Trauma dengan Tetraparesis Frankle C Asia Wahyu Sunaryo Basuki; Dewi Yulianti Bisri; Siti Chasnak Saleh; A. Hmendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (375.426 KB) | DOI: 10.24244/jni.vol7i1.24

Abstract

Cedera medula spinalis akut relatif jarang namun menjadi salah satu kejadian trauma yang berakibat fatal. Kejadian ini sering terjadi pada laki-laki dewasa muda. Kecelakaan lalu lintas merupakan penyebab utama dari kejadian ini, disusul oleh kejadian trauma di rumah, industri dan olahraga. Tujuan utama dari pengelolaan cedera medula spinalis akut adalah mencegah medula spinalis dari cedera sekunder dan memperbaiki fungsi neurologis, mencegah perubahan alignment dan menjaga stabilitas columna vertebralis untuk mendapatkan hasil pemulihan neurologis dan rehabilitasi yang maksimal. Ahli anestesi berperan besar mulai awal pengelolaan secara optimal cedera medula spinalis akut ini. Seorang laki-laki, 57 tahun, dibawa kerumah sakit karena kecelakaan sepeda motor. Pada pemeriksaan fisis, didapatkan laju nafas 24x/menit, nadi 70x/menit, tekanan darah 110/61 mmHg, perfusi baik, GCS 15, dan tetraparesis. Dalam perawatan selanjutnya, terjadi bradikardia (nadi 50-61 x/menit) dan hipotensi (tekanan darah 80-90/40-60 mmHg). Dilakukan laminoplasti dekompresi stabilisasi segera.Perioperative Management Traumatic Cervical Spinal Cord Injury with Tetraparesis Frankle C AsiaAcute spinalis cord injury (SCI) is relatively rare but can be a fatal trauma event. Young adult men are most commonly affected. Traffic accident is a frequent cause, followed by accidents at homes, industries, and in sports. The primary goals of the management of acute SCI are to prevent secondary injury of the spinal cord, improve neurological functions, prevent disruption in alignment, and maintain the stability of the vertebral columns. These serve to achieve neurological recovery and maximal rehabilitation. Anesthesiologists play an important role in the optimal management of acute SCI. A 57-year-old man was brought to the hospital due to a motorcycle accident. Physical examination revealed respiratory rate 24 x/minutes, heart rate 70 x/minutes, blood pressure 110/61 mmHg, good perfusion, GCS 15, and tetraparesis. During hospitalization, the patient developed bradycardia (heart rate 50-61 x/minutes) and hypotension (blood pressure 80-90/40-60 mmHg). Immediate decompressive laminoplasty stabilisation was performed.
Tight Brain pada Anestesi Awake Craniotomy dengan Dexmedetomidine Riyadh Firdaus; Dewi Yulianti Bisri; Siti Chasnak Saleh; A. Hmendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (733.353 KB) | DOI: 10.24244/jni.v6i2.45

Abstract

Anestesi pada awake craniotomy dilakukan dengan menggunakan salah satu atau kombinasi dari teknik scalp block, sedasi dengan propofol dan dexmedetomidine. Teknik ini memfasilitasi awake craniotomy sehingga pemetaan intraoperatif fungsi korteks elokuen yang memfasilitasi reseksi tumor secara radikal. Kebutuhan pemetaan korteks adalah untuk menggambarkan fungsi otak antara lain bicara, sensorik dan motorik dengan tujuan mempertahankan selama dilakukan reseksi. Obat yang diberikan harus dapat memberikan level sedasi dan analgesia yang adekuat untuk mengangkat tulang tetapi tidak mempengaruhi tes fungsional dan elektrokortikografi. Prosedur ini sama dengan kraniotomi standar dengan perbedaan pasien sadar penuh selama pemetaan korteks dan reseksi tumor. Dexmedetomidine adalah suatu agonis adrenoreseptor α-2 spesifik dengan efek sedatif, analgetik, anesthetic sparing effect, efek proteksi otak, tidak adiksi, tidak menekan respirasi dan pasien mudah dibangunkan. Wanita, 54 tahun dengan keluhan utama kejang berulang sejak 3 hari yang lalu. Berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan penunjang pasien didiagnosis tumor lobus frontal kanan. Pasien dilakukan pengangkatan tumor dengan teknik awake craniotomy. Pasien dilakukan scalp block, sedasi dengan propofol dan dexmedetomidine. Saat operasi berlangsung didapatkan kondisi tight brain. Dexmedetomidine dipertimbangkan sebagai salah satu faktor yang mempengaruhi relaksasi otak selama operasi. Lama operasi kurang lebih 5 jam. Pascaoperasi pasien dirawat di HCU.Tight Brain on Awake Craniotomy Anesthesia with DexmedetomidineAnesthesia in awake craniotomy is done using scalp block, propofol sedation, dexmedetomidine sedation or a combination of the three. This technique facilitate awake craniotomy such that intraoperative mapping of eloquent cortical function can be done in radical tumor resection. The need for cortical mapping is to describe and maintain brain function such as speaking, sensoric and motoric function throughout the resection process. The drug given must be able to provide adequate sedation and analgesia for bone removal but do not interfere with the result of function test and electrocorticography. This procedure is similar to other craniotomy, however the patient is alert during cortical mapping and tumor resection and is able to speak after tumor is resected. Dexmedetomidine is an alpha 2 adrenoreceptor agonist with specific effects such as sedation, analgesia, anesthetic sparing, cerebral protection, non addictive, does not suppress respiration, comfortable and easy to recover from. A case of 54 years old female with chief complaint of recurrent seizure in the last 3 days prior to admission is described. Based on history and examination, patient is diagnosed with right frontal lobe tumor. Patient underwent tumor resection using awake craniotomy technique. Scalp block combined with propofol and dexmedetomidine sedation was done. During the surgery, tight brain was encountered. Dexmedetomidine was evaluated as one of the factors that influence the brain relaxation throughout surgery. The Surgery took 5 hours, post surgery patient is observed in HCU.
Co-Authors Dewi Yulianti Bisri Riyadh Firdaus Siti Chasnak Saleh Wahyu Sunaryo Basuki