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INDUKSI PADA PASIEN PEB DENGAN KARDIOMIOPATI DAN EDEMA PARU Suryani, Shila; Prihatno, MM Rudi
MANDALA of Health Vol 7, No 3 (2014): Mandala Of Health
Publisher : Jurusan Kedokteran FK Unsoed

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Preeclampsi is a desease that occur in pragnancy after 20 weeks gestaton with manifestation include multiorgans system such as pulmonary oedema and ventricel disfunction. Cardiomyopathy is a heart disorder that characterized by myocard disfunction and there is no relation with others heart desease before.Â Â Â Â Â Â Â Â Â Â Â This case report discuss about induction anesthesia management to a women, 22 years old diagnosed with GIP0A0, severe preeclampsi, pulmonary oedem, cardiomyopathy, and fetal distress underwent caesaria section. Its a challange for anesthesiologist, how anesthesia management to this patient. There are four thing that we should do when induction, that is : optimalitation of preoxygenation,Â give positive pressure ventilation with PEEP, minimal myocardial depressant effect of drugs, and keep normovolume. By doing these things we can keep adequate oxygenation so that can increase mother and baby outcome

Peran Protease Calpains pada Neurotrauma Prihatno, MM Rudi; Sudadi, Sudadi
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Cedera otak traumatik merupakan kejadian yang dapat berakibat fatal bila tidak mendapatkan penatalaksanaan yang adekuat. Penatalaksanaan tersebut dapat berupa terapi medikamentosa ataupun intervensional non-farmakologik seperti pemberian oksigen dengan ventilasi mekanik, tindakan pembedahan, dan lain sebagainya. Hal terpenting yang paling baik dilakukan adalah penatalaksanaan awal pasca kejadian, dimana proses-proses metabolik di otak sangat mempengaruhi hasil akhir dari kondisi seluler otak. Salah satu yang menjadi pertimbangan adalah penatalaksanaan pencegahan pemburukan dampak cedera otak traumatik dengan intervensi yang memanfaatkan jalur-jalur iskemik yang sudah diketahui, salah satunya adalah protease calpain The Role of Calpains Protease in Neurotrauma Traumatic brain injury is an event that can be fatal if not get an adequate management. Treatment may be either medical therapy or interventional non-pharmacological, such as providing oxygen with mechanical ventilation, surgery, and so forth. The most important thing is best done early post-incident management, in which metabolic processes in the brain greatly affect the outcome of the condition of the brain cell. One of the consideration is the impact of deterioration prevention treatment of traumatic brain injury with interventions that harness ischemic pathways already known, one of which is the protease calpain.

Cardiac Arrest Intra Operatif Pada Neuroanestesi Pediatrik Prihatno, MM Rudi; Manulima, Teguh
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Henti jantung (cardiac arrest) intra operatif merupakan penyulit yang paling menakutkan selama pembedahan berlangsung, terutama pada kasus-kasus bedah saraf pediatrik, dikarenakan akan berpengaruh pada luaran operasi dan dampak jangka panjang yang ditimbulkannya. Resiko yang lebih berat adalah kematian di meja operasi. Seorang anak perempuan 10 bulan dibawa ke RSUD Prof. Dr. Margono Soekarjo oleh orangtuanya dengan keluhan kelemahan anggota gerak sebelah kiri sejak 1 bulan sebelumnya. Pasien rujukan dari salahsatu rumahsakit daerah. Setelah dilakukan tindakan pemeriksaan penunjang, maka disimpulkan dengan diagnosa sementara primitive neuroectoderm tumor (PNET). Pasien direncanakan untuk dilakukan tindakan opeasi bedah saraf elektif. Tindakan anestesi bedah saraf berlangsung selama 180 menit. Selama berlangsungnya operasi pasien mengalami henti jantung (cardiac arrest) pada menit ke-120. Kemudian dilakukan tindakan resusitasi kardiopulmoner. Pasien merespon resusitasi dengan baik. Pasien pasca operasi dibawa ke ruang perawatan intensif. Pasien dirawat di ruang perawatan intensif selama 6 hari, dirawat di ruang bedah saraf selama 4 hari, dan dipulangkan pada hari ke-10 pasca operasi.Intraoperative Cardiac Arrest in Pediatric NeuroanesthesiaIntra-operative cardiac arrest is the most frightening complication during surgery, especially in cases of pediatric neurosurgery, because it will affect the outcome of the operation and the long-term effects it causes. A more severe risk is death at the operating table. A 10-month-old girl was brought to the RSUD Prof. Dr. Margono Soekarjo by his parents with complaints of weakness in the left limb since 1 month before. Patient referral from one regional hospital. After carrying out investigative actions, it is concluded with a provisional diagnosis of primitive neuroectoderm tumor (PNET). Patients are planned for elective neurosurgery surgery. The neurosurgical anesthetic procedure lasts 180 minutes. During the operation, the patient experiences cardiac arrest (cardiac arrest) in the 120th minute. Then cardiopulmonary resuscitation is performed. Patients respond to resuscitation. Postoperative taken to intensive care. The patient was treated in the intensive care room for 6 days, was admitted to the neurosurgical room for 4 days, and sent home on the 10th day postoperatively.

Penggunaan Dexmedetomidin pada Neurotrauma Prihatno, MM Rudi; Lian, Abdul; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 1, No 3 (2012)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Penggunaan dexmedetomidin dalam neurotrauma masih terpecah antara yang setuju dan tidak setuju. Permasalahan ketidaksetujuan adalah dari sisi penilaian terhadap kesadaran pasien, sedangkan yang menyetujui pemberian dexmedetomidin lebih cenderung digunakan sebagai sedasi dan juga efeknya sebagai protektor otak. Permasalahan tersebut diatas dapat dijadikan pertimbangan oleh ahli anestesi dalam penatalaksanaan neurotrauma dengan tetap mempertimbangkan kondisi fisik dan kesadaran pasien dengan harapan agar keselamatan pasien tetap terjaga dengan baik dan tidak memperburuk kondisi pasien. The Use of Dexmedetomidine on Neurotrauma The use of dexmedetomidine in Neurotrauma still divided between the agree and disagree. Disagreement is the issue of the assessment of patient awareness, while approving the provision of dexmedetomidine were more likely to be used as a sedative and also its effect as a brain protector. The problems mentioned above can be considered by an anesthesiologist in the management of Neurotrauma while considering the physical condition and consciousness of the patient with the expectation that patient safety is maintained properly and not worsen the patient's condition.

Penurunan Kadar Glutamat pada Cedera Otak Traumatik Pascapemberian Agonis Adrenoseptor Alpha-2 Dexmedetomidin sebagai Indikator Proteksi Otak Prihatno, MM Rudi; Harahap, M. Sofyan; Akbar, Ieva B; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Latar Belakang dan Tujuan: Dexmedetomidin untuk kasus-kasus neurotrauma masih kontroversi, antara yang setuju dan menolak. Dexmedetomidin sebagai agonis adrenoseptor α2 memiliki beberapa keuntungan dalam kaitannya dengan kemampuannya sebagai neuroprotektan. Penelitian ini bertujuan untuk mengkaji efek neuroproteksi dari dexmedetomidin yang dilihat dari pengaruhnya terhadap penurunan kadar glutamat.Subjek dan Metode Penelitian single blind randomized controlled trial dilakukan pada 16 orang yang datang ke IGD RSUD Prof. Dr. Margono Soekarjo dengan cedera otak traumatik dengan GCS ≤8 pada Mei–Desember 2013. Subjek dibagi dalam 2 kelompok yaitu kelompok dexmedetomidin dan NaCl 0,9%. Pembedahan dilakukan dalam rentang waktu 9 jam pascatrauma. Pemeriksaan kadar glutamat dengan menggunakan metode ELISA. Analisis data menggunakan uji-t dan uji Mann-Whitney.Hasil: Kelompok yang mendapatkan dexmedetomidin menunjukkan bahwa pemberian dexmedetomidin 0,4 μg/kgBB/jam secara kontinyu, menunjukkan penurunan kadar glutamat yang diukur mulai dari awal perlakuan hingga jam ke-24 sebanyak 27,9% (p=0,025), dari jam ke-24 hingga jam-72 sebanyak 9,6% (p=0,208), serta dari awal perlakuan hingga jam ke-72 sebanyak 57,1% (p=0,036). Kelompok yang tidak mendapatkan dexmedetomidin mengalami peningkatan kadar glutamat.Simpulan: Pemberian dexmedetomidin 0,4 μg/kgBB/jam dapat menurunkan kadar glutamat pada pasien cedera otak traumatik dengan GCS ≤ 8. Decreased Level of Glutamate after Administration of Dexmedetomidine (Alpha-2 Adrenoreceptor Agonist) as Neuroprotective Indicator in Traumatic Brain InjuryBackground and Objective: The usage of Dexmedetomidine in neurotrauma cases is still controversial, between the pros and cons. Dexmedetomidine as α2-adrenoceptor agonist has several benefits in concomitant with its properties as neuroprotector. This study aims to evaluate the neuroprotection effect of dexmedetomidine based on the decline in glutamate level.Subject and Method: This single blind randomized controlled trial was done in 16 TBI patients with GCS ≤ 8, recruited from May-December 2013. Subjects were equally divided into 2 groups: dexmedetomidine and 0.9% NaCl group. Surgery was performed within 9 hours post TBI. Glutamate level was examined using ELISA method. Data were analyzed using t-test and Mann-Whitney test.Result: This study showed that glutamate levels in patient who received continuous intravenous dexmedetomidine 0.4 mcg / kg / h were decreased, starting from baseline to 24 h (27.9%, p=0.025), 24 to 72 h (9.6%, p= 0.208) and baseline to 72 h (57.1%, p= 0.036). All patients in NaCl 0.9% group experienced an increase in glutamate level.Conclusion: Administration of dexmedetomidine 0.4 mcg/kg/h in TBI patient with GCS ≤ 8 could decrease glutamate level.

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