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All Journal Majalah Kedokteran Bandung Jurnal Anestesi Perioperatif Jurnal Neuroanestesi Indonesia Majalah Anestesia dan Critical Care Jurnal Anestesi Obstetri Indonesia Jurnal Neuroanestesi Indonesia
Dewi Yulianti Bisri
Departemen Anestesiologi Dan Terapi Intensif Fakultas Kedokteran Universitas Padjadjaran/RSUP Dr. Hasan Sadikin Bandung
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Penatalaksanaan Anestesi Untuk Drainase Abses Otak Pasien Dengan Tetralogi Of Fallot Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v1i2.87

Abstract

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 oksigen–udara, 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 FallotAbstract  Tetralogy 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
Penanganan Anestesi pada Operasi Atlas Meningioma Susanto, Yunita; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/10.24244/jni.vol2iss1p184

Abstract

Angka kejadian spinal meningioma di Amerika adalah 25 % dari seluruh tumor di regio spinal dan empat kali lebih banyak muncul pada perempuan usia lebih dari 40 tahun dibandingkan pada laki-laki. Delapan puluh persen terjadi di daerah vertebra thorakal, 15% di cervikal, 3% di lumbal dan 2% di foramen magnum. Seorang wanita berusia 42 tahun, GCS 15 dengan diagnosa atlas meningioma, yang dilakukan operasi laminectomu untuk pengangkatan tumor. Pasien mengeluh kesemutan mulai dari tangan kiri diikuti tangan kanan, kaki kiri diikuti kaki kanan sejak 10 bulan yang lalu. Sejak 2 bulan yang lalu pasien mengeluh lemas bila berjalan yang disertai kelemahan kedua tangan, disertai keterbatasan gerak dari leher, tidak ada gangguan berkemih dan defekasi.  Intubasi dilakukan dengan cara inline position, operasi berlangsung selama 7 jam dengan total perdarahan 650 cc, rumatan anestesi menggunakan isofluran 0,8–1 vol%, dexmedetomidine 0,2–0,7 mcg/kgbb/jam dan vecuronium  1 mcg/kgbb/mnt. Pascaoperasi pasien tidak diekstubasi, dirawat  Neurosurgery Critical Care Unit (NCCU),  pernafasan dibantu mesin bantu nafas dengan mode Synchronized Intermittent Mandatory Ventilation (SIMV) dan baru diekstubasi 12 jam pascaoperasi. Tiga hari pascaoperasi pasien dipindahkan ke ruangan dengan GCS 15 dan keadaaan hemodinamik stabil.  Anesthesia Management in Atlas Meningioma SurgeryAbstractThe incidence rate of spinal meningioma in the US is 25% of all tumors in the spinal region and appears four times more in women aged over 40 years old than in men. Eighty percent occurs in the thoracal, 15% in the cervical, 3% in the lumbar and 2% in the foramen magnum. This is a case of a 42-year-old woman with GCS 15 who was diagnosed with high cervical meningioma underwent laminectomy tumor removal. Patient experienced numbness on the left referring to the right hand and left referring to the right hand foot since 10 months ago. Since 2 months ago the patient experienced limp with weakness on both hands and limited neck motion. Patients had no disturbance in micturition and defecation. Intubation was done by inline position while the surgery lasted for 7 hours with 650cc bleeding. Anesthesia was maintained using isoflurane 0.8-1 vol %, dexmedetomidine 0.2-0.7 mcg/kg/h and vecuronium 1 mcg/kg/mnt. After surgery, the patient was not extubated and admitted to NCCU (Neurosurgery Critical Care Unit) with ventilator-mode SIMV (Synchronized Intermittent Mandatory Ventilation). Extubation was performed 12 hours postoperative. Three days after surgery patient was transferred to inpatient ward with GCS 15 and stable hemodynamic status.
Insidensi Hipoksemia dan Hipotensi pada Cedera Otak Traumatik di RSUP Dr. Hasan Sadikin Bandung Tahun 2015 Arif, Izhar Muhammad; Usman, Hermin Aminah; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i2.41

Abstract

Latar Belakang dan Tujuan: Cedera otak traumatik (COT) merupakan kasus cedera dengan prevalensi ketiga terbesar diantara cedera bagian tubuh lain (16,8%) di Indonesia. Hipotensi dan hipoksemia adalah prediktor luaran COT yang dapat dikontrol. Penelitian ini bertujuan untuk mengetahui insidensi hipotensi dan hipoksemia pada pasien COT., yang masuk di unit Gawat Darurat Rumah Sakit Dr. Hasan Sadikin.Subjek dan Metode: Penelitian ini berupa deskriptif kuantitatif. Data diambil secara retrospektif dari rekam medis pasien dengan diagnosis COT yang masuk ke Unit Gawat Darurat RSUP Dr. Hasan Sadikin periode 1 Januari 2015–31 Desember 2015. Sampel diambil secara total sampling, kemudian diklasifikasikan berdasarkan usia, jenis kelamin, etiologi cedera, tingkat COT, saturasi oksigen, dan tekanan darah pasien.Hasil: Didapatkan 669 sampel penelitian. Rata-rata umur sampel adalah 29 tahun dengan jumlah terbanyak di kelompok umur 15–24 tahun (30,3%). Kejadian pada laki-laki (71,2%) lebih tinggi dibandingkan perempuan (28,8%). COT paling banyak disebabkan oleh kecelakaan lalulintas (KLL) (68,9%). Terdapat 78 (11,7%) kasus COT berat. Pasien COT yang mengalami hipotensi dan hipoksemia sebanyak 50 orang (7,5%), dan angka kejadian hipotensi dan hipoksemia paling tinggi terdapat pada pasien COT berat (66%). Simpulan: Proporsi kejadian hipoksemia dan hipotensi paling banyak terjadi pada COT berat dengan etiologi KLL.Hypoxaemia and Hypotension Incidence of Traumatic Brain Injury in Dr. Hasan Sadikin Hospital Bandung in 2015Background and Objectives: Traumatic brain injury (TBI) is a case with the third highest prevalence among other injuries (16,8%) in Indonesia. Hypotension and hypoxaemia are TBI outcome predictors which can be controlled. This research aims to find out the incidence of hypotension and hypoxaemia in TBI patients.Subjects and Method: This descriptive quantitative research collected the data retrospectively from the medical record of COT patients who were admitted to Emergency Room (ER) Dr. Hasan Sadikin Public General Hospital in 1 January – 31 December 2015. Samples were collected with total sampling technique, and classified based on age, gender, etiology, TBI severity level, oxygen saturation, and blood pressure of the patients.Results: 669 samples were collected. Age average of the samples was 29 years with the highest age group frequency being 15-24 years (30,3%). There were more male patients (71,2%) compared to the female ones (28,8%). The most common cause of TBI was traffic accidents (68,9%). There were 78 (11,7%) severe TBI cases. There were 50 (7,5%) TBI patients with hypoxaemia and hypotension, and the most hypotension and hypoxaemia cases were in severe TBI patients (66%).Conclusion: The proportion of hypoxaemia and hypotension incidence was the highest in severe TBI patients due to traffic accidents.
Manajemen Anestesi pada Penderita Sindroma Pfeiffer dengan Posisi Sphinx Halimi, Radian Ahmad; Bisri, Dewi Yulianti; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v7i3.13

Abstract

Sindroma pfeiffer adalah kelainan genetik autosomal dominan berupa fusi prematur tulang kepala dan tubuh lainnya. Operasi rekonstruksi kraniofasial pada pasien dengan sindrom pfeiffer memberikan tantangan tersendiri bagi ahli anestesi. Pada laporan kasus ini, seorang anak perempuan berusia 18 bulan datang ke rumah sakit Hasan Sadikin Bandung dengan keluhan kelainan bentuk kepala sejak lahir. Kelainan tersebut disertai dengan proptosis mata, hipoplasia maksila bilateral, high arc palate, hipotelorisme dan hidrosefalus, namun tidak terdapat riwayat obstruksi jalan nafas. Pasien direncanakan dilakukan prosedur rekonstruksi kraniofasial dan tarsorhaphy dengan posisi modifikasi prone (posisi sphinx). Permasalahan yang terjadi selama operasi adalah obstruksi vena juguler, perdarahan dan kebocoran cairan serebrospinal pascaoperasi. Operasi berlangsung selama 19 jam. Pascaoperasi pasien dirawat di PICU dan dipindahkan ke ruangan perawatan biasa pada hari ke 4. Penanganan perioperatif pasien dengan sindroma pfeiffer yang akan menjalani prosedur operasi kraniofasial membutuhkan penanganan secara multidisiplin dan dibutuhkan pemahaman yang mendalam mengenai fisiologi, potensi permasalahan intraoperasi, resiko dan komplikasi pascaoperasi untuk mencapai hasil luaran yang baikAnesthesia Management in Patients with Pfeiffer Syndrome with Sphinx PositionPfeiffer syndrome is a dominant autosomal genetic disorder characterized by premature fusion of head and other body bones. Craniofacial reconstruction surgery in patients with Pfeiffer syndrome presents a challenge for an anaesthesiologist. This case report discusses about 18 month old girl came to the Hasan Sadikin hospital in Bandung with complaints of clover head shape from birth. The other abnormalities consist of eye proptosis, bilateral maxilla hypophlasia, high arc palate, hypotelorism and hydrocephalus. There was no history of obstructive sleep apneau (OSA). The patient underwent craniofacial vault reconstruction procedure and a tarrsorhaphy with modified prone position (sphinx position). During the operation, there were problems occured such as jugular venous obstruction, bleeding and postoperative cerebrospinal fluid leakage. The procedure takes 19 hours long, and after the operation, the patient admitted to the PICU and being transferred to the ward on day-4. The perioperative treatment of patients undergoing craniofacial surgery requires a multidisciplinary treatment approach, and deep understanding of the physiology, potential intraoperative problems, risks and postoperative complications to achieve better outcomes.
Pengelolaan Hipertensi Intrakranial yang Membandel pada Cedera Otak Traumatik Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v7i2.14

Abstract

Hipertensi intrakranial yang membandel (intractable/refracter/malignant intracranial hypertension) didefinisikan sebagai peningkatan tekanan intrakranial (intracranial pressure/ICP) lebih dari 25 mmHg selama 30 menit, 30 mmHg selama 15 menit, atau 40 mmHg selama 1 menit. Definisi lain adalah peningkatan ICP sebagai peningkatan spontan ICP >20 mmHg selama 15 menit dalam periode 1 jam meskipun telah dilakukan intervensi first-tier secara optimal atau ICP >25 mmHg untuk 1-12 jam. Hipertensi intrakranial adalah kelainan yang dapat berakibat fatal. Mortalitas tertinggi dari hipertensi intrakranial terlihat pada pasien dengan cedera kepala berat, yang mana peningkatan ICP sangat ekstrim dan sering membandel terhadap terapi. Masalah utama peningkatan ICP adalah iskemia dan herniasi. Tindakan untuk terapi hipertensi intrakranial adalah pasang monitor ICP, pertahankan cerebral perfusion pressure (CPP) 50-70 mmHg, first-tier therapy dan second-tier therapy. Indikasi pemasangan monitor ICP adalah 1) abnormal CT scan dan skor GCS 3-8 setelah dilakukan resusitasi yang adekuat untuk syok dan hipoksia, 2) normal CT scan dan skor GCS 3-8 disertai dengan 2 atau lebih hal-hal berikut:  umur > 40 tahun, posturing, atau tekanan darah sistolik < 90 mmHg. Terapi untuk menurunkan ICP dimulai pada level ICP 20-25 mmHg.  First-tier therapy untuk terapi peningkatan tekanan intrakranial adalah: 1) CSF drainase melalui kateter intraventricular, 2) diuresis dengan mannitol, 0,25-1,5 g/kg berikan lebih 10 menit, 3) moderate hiperventilasi.Bila tekanan intrakranial membandel terhadap first-tier therapy  (intractable) lakukan second-tier therapy yaitu hiperventilasi untuk mencapai PaCO2 < 30 mmHg (dianjurkan memasang monitor SJO2, AVDO2, dan/atau CBF), dosis tinggi terapi barbiturat, hipotermia,  terapi hipertensif, dekompresif kraniektomi.The Management of Intractable Intracranial Hypertension in Traumatic Brain InjuryIntractable intracranial hypertension (refractory/malignant intracranial hypertension) defined as intracranial pressure (ICP) that exceed 25 mmHg for 30 minutes, 30 mmHg for 15 minutes, or 40 mmHg for 1 minute. Other definition are refractory elevation in ICP as a spontaneous increase ICP >20 mmHg during 15 minutes within a 1 hour period despite optimized first-tier intervention or ICP >25 mmHg for 1-12 hour. Intracranial hypertension is a potentially fatal disorder. The highest mortality from intracranial hypertension is seen in patient with severe head injury, in whom elevations in intracranial pressure are extreme and frequency resistant to treatment. Main problem of increased intracranial pressure (ICP) are ischemia and herniation.Treatment of intracranial hypertension includes insert ICP monitor, maintenance CPP 50-70 mmHg, first-tier therapy and second-tier therapy. Indication for insertion of an ICP monitor include 1) an abnormal CT scan and  a GCS score  of 3 to 8 after adequate resuscitation of shock and hypoxia, 2) normal CT scan and a GCS  of 3 to 8 accompanied by two or more the following at admitted hospital: age > 40 years, posturing, or systolic blood pressure of < 90 mmHg. Treatment to decrease ICP usually initated at ICP level of 20-25 mmHg. The aim is to maintain CPP 50-70 mmHg. First-tier therapy involves the following: 1) incremental CSF drainage via an intraventricular catheter, 2) diuresis with mannitol, 0.25-1.5 g/kg over 10 minutes, 3) moderate hyperventilation. If intracranial hypertension intractable to first-tier therapy, do second-tier therapy: hyperventilation to achieved PaCO2 < 30 mmHg (SJO2, AVDO2, and/or CBF monitoring is recommended), high dose barbiturate therapy, consider hypothermia, consider hypertensive therapy, consider decompressive craniectomy.
Manajemen Anestesi Stroke Perioperatif Bisri, Dewi Yulianti; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra; Permatasari, Endah
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v7i1.29

Abstract

Stroke perioperatif merupakan suatu kejadian katastropik yang meningkatkan mortalitas dan morbiditas, terutama pada usia di atas 65 tahun. Stroke perioperatif merupakan suatu momok (kejadian yang tidak diharapkan) bagi keluarga dan rekan sejawat yang merawat. Stroke perioperatif dapat bersifat iskemik atau hemoragik yang terjadi selama masa intraoperatif hingga 30 hari pascaoperasi. Faktor risiko terjadinya stroke perioperatif diantaranya adalah: usia lanjut, riwayat stroke dan Transient Ischemic Attack (TIA) sebelumnya, atrial fibrilasi, kelainan pembuluh darah dan metabolik. Umumnya stroke perioperatif tidak terjadi selama masa pembedahan atau saat pulih sadar, tetapi terjadi dalam 24 jam pertama pascabedah. Penanganan stroke perioperatif membutuhkan manajemen yang menyeluruh dan suatu kerjasama tim yang baik. Walaupun kejadiannya tidak banyak namun membutuhkan penanganan tepat karena tingkat morbiditas dan mortalitas yang tinggi serta mengakibatkan lama perawatan memanjang. Identifikasi awal pasien dan manajemen terpadu lintas keilmuan harus dilakukan untuk mencegah luaran yang buruk setelah terjadinya stroke perioperatif.Anesthetic Management of Perioperative StrokePerioperative stroke can be a catastrophic outcome for surgical patients and is associated with increased morbidity and mortality, especially in the age above 65. A perioperative stroke is an unexpected event for families and caring colleagues. A perioperative stroke may be an ischemic or haemorrhagic disorder that occurs intraoperatively or up to 30 days postoperatively. Risk factors for perioperative stroke include elderly, history of previous stroke and transient ischemic attack (TIA), atrial fibrillation, vascular and metabolic disorder. Most perioperative stroke generally does not occur during the intraoperative period or soon after recovering period but within the first 24 hours. Handling perioperative stroke requires a thorough management and a good teamwork. Perioperative stroke can be devastating, as they not only result in death but also prolong the length of hospital stay, increasing cost and greater likelihood of discharge to long term care facilities. Although the incidence is not much but this requires appropriate treatment because of high morbidity and mortality and also result in prolong length of hospital stay. Early identification and expeditious management involving a multidisciplinary approach is the key to avoid a poor outcome following perioperative stroke.
Penatalaksanaan Anestesi pada Reseksi Tumor Batang Otak Krisna J. Sutawan, Ida Bagus; Bisri, Dewi Yulianti; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 6, No 2 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i2.44

Abstract

Batang otak adalah komponen dari fossa posterior, oleh karena itu penatalaksanaan anestesi pada reseksi tumor di batang otak tentunya mengikuti prinsip-prinsip umum penatalaksanaan anestesi pada fossa posterior ditambah dengan perhatian khusus terhadap komplikasi yang mungkin terjadi pada saat melakukan manipulasi pada batang otak. Seorang laki-laki 41 tahun dengan tumor batang otak mengeluh adanya pengelihatan ganda, rasa tebal dan nyeri pada wajah serta gangguan menelan, pada MRI ditemukan lesi difus batas tidak tegas di daerah pons sampai mid brain, curiga tumor otak primer (low grade tumor), nervus optikus dan kiasma optikum kanan kiri tampak normal. Pasien berhasil dianestesi dengan baik digunakan TCI- propofol monitoring standar ditambah monitoring invasif artery line dan pemasangan kateter vena sentral, intraoperatif pasien mengalami episode hipotensi tekanan darah (70/40 mmHg) dan bradikardia, (laju nadi 35 x/menit), oksigen 50%, fentanyl sevofluran dan rekuronium, digunakan akibat manipulasi pada batang otak. Postoperatif pasien dirawat di ICU dan diextubasi 12 jam kemudian.Anesthesia Management in Brain Steam Tumor ResectionBrain steam is a component of fossa posterior, ther fore anesthesia management for brain steam tumor resection should follow the general rule for anesthesia management of fossa posterior and a special concern for complication that could happen when brain steam is manipulated. Forty one year old male with a brain steam tumor complain a double vision, numbness and pain on the face, and swallowing problem, MRI show diffuse lesion on the pons to mid brain, suspect primary brain tumor (low grade tumor), nervus opticus and chiasma opticum are normal. Patient has been anesthesied well using TCI propofol, oxygen 50%, fentanyl, sevoflurane and rocuronium using invasive monitoring artery line and central venous catheter (CVC) in addition to standart monitoring. Intraoperatifly patient going through a hypotensive episode (blood pressure 70/40 mmHg) and bradycardia (heart rate 35x/minute that caused by manipulation on the brain steam. Postoperatifly patient is in the ICU and extubated on next 12 hours.
Gambaran Epidemiologi Pasien Stroke Dewasa Muda yang Dirawat di Bangsal Neurologi RSUP Dr.Hasan Sadikin Bandung Periode 2011–2016 Syifa, Nadia; Amalia, Lisda; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i3.50

Abstract

Latar Belakang dan Tujuan: Kerugian akibat stroke lebih berat pada penderita yang berusia lebih muda dibandingkan usia tua. Insidensi stroke dewasa muda terus meningkat di berbagai negara. Pencegahan yang tepat dapat dilakukan dengan melakukan studi epidemiologi. Penelitian ini bertujuan untuk mengetahui gambaran epidemiologi pasien stroke dewasa muda. Subjek dan Metode: Penelitian ini merupakan studi kuantitatif dengan metode deskriptif. Data yang digunakan adalah resume rekam medis pasien stroke yang dirawat di bangsal neurologi Rumah Sakit Dr.Hasan Sadikin(RSHS) Bandung tahun 2011–2016. Data kemudian diklasifikasikan berdasarkan kelompok usia, jenis kelamin, tipe stroke, demografi, dan faktor risiko.Hasil: Sampel yang didapatkan sejumlah 450 buah. Jumlah kasus stroke terbanyak berada pada kelompok umur 42–45 tahun (45,11%). Kejadian stroke iskemik (50,44%) lebih tinggi dibandingkan kejadian stroke perdarahan (49,56%). Kejadian pada perempuan (56,66%) lebih tinggi dibandingkan laki-laki (43,34%). Pendidikan terakhir penderita paling banyak adalah SMA (32,89%). Kelompok pekerjaan terbanyak adalah kelompok tidak bekerja (56,22%). Faktor risiko terbanyak adalah hipertensi (42,06%). Simpulan: Kejadian stroke dewasa muda di RSHS paling banyak terjadi pada kelompok usia 42-45 tahun, tipe stroke iskemik, jenis kelamin perempuan, pendidikan terakhir SMA, tidak bekerja, dan faktor risiko tertinggi adalah hipertensi. Epidemiological Picture of Young Adult Stroke Patients treated in Neurology Ward of RSUP Dr.Hasan Sadikin Bandung 2011–2016 PeriodBackground and Objectives: The stroke loss is higher in younger patients compared to the older patients. Stroke incidence is increasing year by year. Epidemiological study can be used as the basis of prevention and reduction of young adult stroke incidence. This study aims to determine the epidemiological picture of young adult stroke patientsSubjects and Method: This study is a quantitative study using descriptive method. The datas were taken from the resume of medical records of patients that are diagnosed as stroke and treated in the neurology ward Dr.Hasan Sadikin Hospital(RSHS) in 2011 - 2016. All samples were taken then classified by its age group, sex, stroke type, demographical characteristic and risk factor. Result: 452 samples were obtained. The highest number of cases are found in the 42-45 year old group (45,11%). Ischemic stroke (50,44%) cases are higher compared to the hemorrhagic stroke (49,56%). Stroke cases in women (56,66%) is higher than in men (43,34%). Most of the patient’s last education is high school (32,89%). Most of the patients who have stroke are unemployed (56,22%). The most risk factor is hypertension (42,06%). Conclusion: Stroke cases in RSHS happen to be higher in older age group, ischemic stroke type, women, high school as the last education, unemployment and the highest risk factor is hypertension.
Pengelolaan Perioperatif Cedera Medula Spinalis Servikal karena Trauma dengan Tetraparesis Frankle C Asia Basuki, Wahyu Sunaryo; Bisri, Dewi Yulianti; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v7i1.24

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.
Perbandingan Antara Fentanil 2 μg/kgBB/jam dan Scalp Block Terhadap Peningkatan Hemodinamik dan Kadar Glukosa Darah Sewaktu Saat Pemasangan Pin Kepala Pada Kraniotomi Sihombing, Robert; Bisri, Dewi Yulianti; Sitanggang, Ruli Herman
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v7i2.5

Abstract

Latar Belakang dan Tujuan: Opioid dosis tinggi efektif memblokade nyeri pada operasi kraniotomi namun memiliki efek yang tidak diinginkan. Alternatif lain menggunakan teknik scalp block dikombinasikan dengan anestesi umum. Tujuan penelitian ini untuk membandingkan hemodinamik dan kadar glukosa darah sewaktu (GDS) antara fentanil 2 μg/kgBB/jam dan scalp block saat pemasangan pin kepala pada kraniotomi pengangkatan tumor elektif dengan anestesi umum. Subjek dan Metode: Penelitian ini dilakukan pada 28 pasien yang direncanakan pembedahan tumor otak elektif. Subjek penelitian dibagi menjadi dua kelompok: scalp block dan kelompok fentanil 2 μg/kgBB/jam. Tekanan arteri rerata, laju nadi dan kadar GDS intraoperatif dinilai dan dianalisis menggunakan uji-t berpasangan dan Chi-square.Hasil: MAP dan laju nadi antara kedua grup memiliki perbedaan signifikan (p<0,05). Kelompok fentanil memiliki MAP dan laju nadi lebih tinggi dibanding dengan kelompok scalp block. Namun perbandingan kadar GDS antara kedua kelompok tidak menunjukkan hasil yang signifikan (p>0,05).Simpulan: Scalp block lebih efektif dalam mengurangi peningkatan hemodinamik namun sama efektif dengan fentanil 2 μg/kgBB/jam dalam mengurangi peningkatan kadar GDS pada pasien yang menjalani operasi kraniotomi pengangkatan tumor elektif.Comparison Between Fentanyl 2 μg/kg/hr and Scalp Block of Hemodynamic Improvement and Blood Glucose Levels During Head Pin Installment in CraniotomyBackground and Objective: High dose opioids is one of the most effective techniques for blocking pain in craniotomy surgery but it has undesirable effect. Other alternative to overcome pain in craniotomy is using a scalp block technique in combination with general anesthesia. The aim of this study was to compare the increase of hemodynamic and blood glucose levels (BGL) between fentanyl 2 μg/kgBW/hr and scalp block during head pin installment in craniotomy surgery.Subject and Method: Twenty eight patients undergoing elective craniotomy tumor removal surgery were enrolled in the study. The patients were divided into two groups: scalp block and fentanyl 2 μg/kgBW/hr. Intraoperative mean arterial pressure (MAP), heart rate (HR) and BGL were recorded, and analyzed by paired t-test and Chisquare.Result: MAP and HR showed significant differences between groups (p<0,05), wherein fentanyl group had higher MAP and HR than scalp block group. However, BGL during head pin installment did not show significant results between the two groups (p> 0,05).Conclusion: Scalp block is more effective than fentanyl 2 μg/kgBW/hr in reducing increased of hemodynamic but equally effective with fentanyl in reducing increased of BGL during head pin installment in craniotomy tumor removal.
Co-Authors A Himendra Wargahadibrata A Himendra Wargahadibrata A. Himendra Wargahadibrata A. Hmendra Wargahadibrata A. Hmendra Wargahadibrata Achmad Adam Achmad Adam, Achmad Adriman, Silmi Ahmado Oktaria Alifan Wijaya Andy Hutariyus Arief Cahyadi Arif, Izhar Muhammad Arna Fransisca Ayu Rosema Sari Bambang J. Oetoro Bambang J. Oetoro Bambang J. Oetoro Basuki, Wahyu Sunaryo Boesoirie, M. Adli Caroline Wullur Chrismas Gideon Bangun Cindy Giovanni Deni Nugraha Diana C Lalenoh Dini Handayani Putri Djefri Frederik Longdong Doddy Tavianto Endah Permatasari Endy Sugiyanto Eri Surahman Firdaus, Riyadh Fitri Sepviyanti Sumardi Fitri Sepviyanti Sumardi Giovanni, Cindy Hana Nur Ramila Hermin Aminah Usman I Gede Sutaniyasa Ida Bagus Krisna Jaya Sutawan Ike Sri Redjeki Indria Sari Iwan Abdul Rachman Iwan Fuadi Izhar Muhammad Arif Lira Panduwaty Lira Panduwaty Lisda Amalia M Sofyan Harahap M Sofyan Harahap M, Mutivanya Inez M. Adli Boesoirie M. Sofyan Harahap M. Sofyan Harahap Mangastuti, Rebecca Sidhapramudita Marsudi Rasman Michaela Arshanty Limawan Monika Widiastuti Muhammad Arshad Muhammad Habibi Mutivanya Inez M Mutivanya Inez Maharani Nadia Syifa Nazaruddin Umar Nopian Hidayat Nurmala Dewi Maharani Oetoro, Bambang J. Okky Harsono Oktaria, Ahmado Permatasari, Endah Putri, Dini Handayani Radian Ahmad Halimi Rasman, Marsudi Rebecca Sidhapramudita Mangastuti Renaldy Sobarna Riki Punisada Riyadh Firdaus Robert Sihombing RR. Sinta Irina Ruli Herman Sitanggang Saleh, Siti Chasnak Saputra, Tengku Addi Sigit Sutanto Sihombing, Robert Silmi Adriman Siti Chasnak Saleh Siti Chasnak Saleh Siti Chasnak Saleh Siti Chasnak Saleh Sri Rahardjo Sri Rahardjo Sudadi Sudadi Sudadi Sudadi Susanto, Yunita Sutanto, Sigit Syafruddin Gaus Syahpikal Sahana Syaruddin Gaus Syifa, Nadia Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tatang Bisri Tengku Addi Saputra Wahyu Sunaryo Basuki Wahyu Sunaryo Basuki Wargahadibrata, A. Hmendra Wullur, Caroline Yuanda Rizawan Putra Yunita Susanto Yusmein Uyun