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All Journal Jurnal Neuroanestesi Indonesia Majalah Anestesia dan Critical Care
Wullur, Caroline
Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung
Health Professions Library & Information Science Medicine & Pharmacology Neuroscience Public Health Social Sciences

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Penatalaksanaan Anestesi pada Pasien dengan Tumor Supratentorial Berukuran Besar Suspek Konveksitas Meningioma Wullur, Caroline; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Penatalaksanaan anestesi untuk kasus meningioma memiliki beberapa hal khusus yang penting untuk dilaksanakan. Jaringan otak tertutup oleh tulang kranium. Karena hubungan kontinu dari aliran darah dan volume jaringan otak, maka resiko perdarahan dan edema sangat tinggi. Tanpa pendekatan anestesi yang tepat, maka dapat meningkatkan resiko edema dan perdarahan otak karena manipulasi operasi. Pada kasus ini dilaporkan pasien berusia 35 tahun dengan keluhan nyeri kepala di daerah frontal disertai dengan penurunan penglihatan sejak 1 tahun sebelum masuk rumah sakit. Pasien tidak pernah mengalami kejang ataupun penurunan kesadaran. Pasien didiagnosa dengan tumor supratentorial ec suspek conveksitas meningioma yang direncanakan dilakukan pembedahan kraniotomi untuk pengangkatan tumor. Status fisik ASA 2 dengan defisit neurologis. Pasien dilakukan dengan anestesi umum dengan intubasi. Induksi dengan fentanil, propofol dan vecuronium. Operasi berlangsung selama 7,5 jam. Pascabedah, pasien dirawat di Unit Perawatan Intensif selama 2 hari sebelum pindah ke ruangan. Perlakuan anestesi dan pengaturan faktor fisiologi mempunyai dampak yang besar terhadap jaringan otak. Dokter anestesi harus mempunyai pengetahuan mengenai efek obat dan manipulasi lainnya untuk mencapai hasil operasi yang baik. Anaesthetic Management of a Patient with Large Supratentorial Brain Tumor Suspected Convexity MeningiomaAnesthesia for meningioma cases has several specific important considerations. The brain is enclosed in a rigid skull. Brain tissue is highly vascularized therefore the risk of bleeding and edema are very high. Without the correct anaesthetic approach, the risk of bleeding and edema due to surgical manipulation may be increased. This phenomenon may have negative impact since the visual of surgical field will be limited. In this case, we reported a 35-year old female patient with severe headache at the frontal region accompanied with visual impairment since 1 year prior to hospital admittance. This patient was never experienced any seizures or inconsiousness. Patient was diagnosed with supratentorial tumor caused by suspect of convexity meningioma and was planned tumor removal craniotomy. ASA II physical status with neurological deficit. The patient was on general anaesthesia with intubation. Induction was performed using fentanyl, propofol and vecuronium while continuous propofol and vecuronium were used for maintenance. The surgery lasted for 7.5 hours. After surgery, the patient was treated in the Intensive Care Unit for 2 days prior to inpatient ward transfer. Anaesthetic management and physiological factors control have a positive impact on the brain tissue. Anaesthesiologist must have the comprehensive knowledge on drug effects and other manipulations to achieve positive result of a surgery.
Penatalaksanaan Anestesi untuk Gabungan Tindakan Seksio Sesarea dan Kraniotomi Tumor Otak Wullur, Caroline; Boesoirie, M. Adli; Bisri, Dewi Yulianti
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Angka kejadian tumor intrakranial pada masa kehamilan sangat jarang. Keluhan seperti mual, muntah, nyeri kepala dan gangguan penglihatan serupa dengan hiperemesis dan eklampsia. Sebagian besar pasien tidak memerlukan tindakan emergensi namun pada beberapa kasus, kraniotomi tumor otak dilakukan lebih awal atau bahkan bersamaan dengan seksio sesarea. Seorang wanita 40 tahun, G3P2A0 datang dengan penurunan kesadaran GCS 6 (E2M2V2). CT-scan menunjukkan adanya masa pada daerah temporoparietal kiri, curiga high grade glioma, disertai dengan pergeseran midline dan perdarahan intratumoral. Pemeriksaan obstetri menunjukkan usia kehamilan 32 minggu dengan gawat janin. Dengan pertimbangan resiko herniasi dan gawat janin, pasien menjalani operasi emergensi seksio sesarea diikuti dengan kraniotomi tumor otak. Operasi berlangsung selama 6 jam. Pada pasien hamil dengan tumor otak, waktu pembedahan bergantung pada jenis tumor, usia kehamilan dan kondisi janin. Keberhasilan anestesi bergantung pada pengetahuan menyeluruh mengenai fisiologi dan farmakologi wanita hamil yang disesuaikan dengan individu terkait untuk mengontrol tekanan intrakranial, dengan tujuan menjaga kesejahteraan ibu dan anak. Anaesthetic Management for Combined Emergency Cesarean Section and Craniotomy Tumor RemovalThe occurrence of primary intracranial tumors in pregnancy is an extremely rare event. Symptoms of brain tumor include nausea, vomitting, headache, visual disturbances and seizures which mimic symptoms of pregnancy-related hyperemesis or eclampsia. These central nervous system disorders seldom require immediate surgical attention during pregnancy. However in very few cases, craniotomy tumor removal is performed earlier or even simultaneous with fetal delivery. A 40-year-old woman at 32 weeks of gestation presented to the emergency room with decreased level of consciousness GCS 6 (E2M2V2). CT scan revealed a mass lesion over the left temporoparietal region, suggestive of a high grade glioma, with midline shift and intratumoral bleeding. Obstetric examination revealed a single live fetus of 32 weeks gestation in distress. In view of high risk of herniation and fetal distress, she underwent emergency cesaren section followed by craniotomy tumor removal. Both procedures were completed in 6 hours. In a parturient with brain tumor, the time of combined surgery of tumor removal and cesarean section is decided upon clinical symptoms, type of tumor, gestational age and fetal viability. A successful anaesthetic management requires a comprehensive knowledge of physiology and pharmacology, individually tailored to control intracranial pressure while ensuring the safety of both mother and fetus.
Perbandingan antara Sevofluran dan Isofluran terhadap Gangguan Fungsi Kognitif Pascabedah Tumor Otak menggunakan Mini Mental State Examination (MMSE Wullur, Caroline; Redjeki, Ike Sri; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 5, No 3 (2016)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Latar Belakang dan Tujuan: Pasien dengan tumor otak sering mengalami gangguan fungsi kognitif yang berdampak terhadap fungsi fisik, psikologis, sosial, dan vokasional. Post operative cognitive dysfunction (POCD) adalah ganggguan kognitif pascabedah yang paling sering terjadi. Anestesi umum yang digunakan dapat berpengaruh terhadap gangguan fungsi kognitif. Anestetika inhalasi sevofluran dan isofluran merupakan anestetika inhalasi yang paling sering digunakan untuk prosedur kraniotomi tumor otak. Tujuan penelitian adalah untuk mengetahui perbandingan efek antara sevofluran dan isofluran terhadap fungsi kognitif pascabedah tumor otak.Subjek dan Metode: eksperimental acak terkontrol buta tunggal melibatkan 44 pasien dengan tumor otak yang menjalani kraniotomi tumor otak pada bulan April−Oktober 2015. Data dianalisis dengan uji-t tidak berpasangan, Chi kuadrat, Mann Whitney dan Komolgorov Smirnov, nilai p<0,05 dianggap bermakna. Fungsi kognitif diukur menggunakan uji mini mental state examination (MMSE) yang dinilai saat pre-operatif dan pascabedah pada jam ke 6, 12, 18, 24, 48, 72, 96, dan 120. Hasil penelitian menunjukkan MMSE pascabedah pada kelompok anestetika inhalasi sevofluran lebih tinggi dibanding dengan isofluran pada 6, 12, 18, 18, 24, 48 dan 72 jam pascabedah dengan perbedaan bermakna (p<0,05).Simpulan: Anestetik inhalasi sevofluran menimbulkan gangguan fungsi kognitif pascabedah yang lebih ringan dibanding dengan isofluran pada pasien yang menjalani kraniotomi tumor otak.Comparison between Sevoflurane and Isoflurane on Cognitive Dysfunction Post Craniotomy Tumor Removal assessed using Mini Mental State Examination (MMSE)Background and Objective: Patients with brain tumor often experience cognitive dysfunction that may have an impact on physical functioning, psychology, social and vocacional functioning. Post operative cognitive dysfunction (POCD) is the most common post surgical cognitive dysfunction. General anaesthesia may have an impact on POCD. Sevofluran and isoflurane are the two most commonly used inhaled anaesthetic agents for craniotomy tumor removal. The aim of this study is to compare the effects between sevoflurane and isoflurane on cognitive functions after brain tumor surgery. Subject and Method: This is a randomized controlled trial involving 44 ASA II patients who underwent craniotomy tumor removal under general anaesthesia between period of April−October 2015. Statistical analysis using unpaired t-test, Chi Square, Mann Whitney and Komolgorov Smirnov test with p<0,05 as statistically significant. Cognitive function was assessed using mini mental state examination (MMSE) preoperatively and postoperatively at 6, 12, 18, 24, 48, 72, 96 and 120 hour postoperative. Result: shows that postoperative MMSE was higher in sevoflurane group compared to isoflurane on 6, 12, 18, 24, 48, 72 hours postoperatively with statistical significance (p<0,05). Conclusion: Inhaled anaesthetic agent sevoflurane causes less postoperative cognitive disturbance compared to isoflurane on patients undergoing craniotomy tumor removal.
Anaesthetic Management for a Patient with Uterine Perforation Due to Gestational Trophoblastic Disease with Hyperthyroidism wullur, caroline; Rismawan, Budiana
Majalah Anestesia dan Critical Care Vol 33 No 2 (2015): Juni
Publisher : Perdatin Pusat

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Gestational trophoblastic disease originates from abnormal proliferation of molar tissue and most of them are not complicated. However, life threatening condition such as hyperthyroidism may occur. Often, the diagnosis of hyperthyroid state is a retrospective one, as it can be missed in the emergency scenario of patient requiring molar evacuation. Trophoblastic hyperthyroidism poses a multiple of challenges to the anaesthesiologist. High output cardiac failure secondary to thyrotoxicosis, thyroid storm, hypertension and disseminated intravascular coagulation may occur in the perioperative period. We report a successful anaesthetic management of a patient with gestational trophoblastic disease with manifestations of hyperthyroidism whom underwent a trans-abdominal hysterectomy.
Respiratory Failure due to Transfusion Related Acute Lung Injury (TRALI) and Atelectasis and Acute Kidney Injury Post Cardiac Surgery: A Case Report wullur, caroline; Sitanggang, Ruli Herman
Majalah Anestesia dan Critical Care Vol 33 No 1 (2015): Februari
Publisher : Perdatin Pusat

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Postoperative pulmonary complications and acute kidney injuries are the most frequent and significant contributor to morbidity, mortality and costs associated with hospitalization. Despite the prevalance of these complications in cardiac surgery patients, recognition, diagnosis and management of this problem vary widely. Many factors may contribute to the pathogenesis of lung complications include atelectasis, Transfusion Related Acute Lung Injury (TRALI) and Acute Respiratory Distress Syndrome (ARDS). While haemodynamic, inflammatory and nephrotic factors are involved and overlap each other in leading to kidney injury. A 54-year-old patient with history of hypertension and diabetes melitus underwent coronary artery bypass graft. On postoperative day 1, he had worsening respiratory and renal function with suspected atelectasis and TRALI. Alveolar lung recruitment maneuvers as well as Sustained Low-Efficiency Dialysis (SLED) were conducted. He was transferred to regular ward on postoperative day seven and discharged uneventfully two days later. Early recognition and management including alveolar recruitment maneuvers and dialysis have an important role in the prevention and treatment of these complications.
Penatalaksanaan Aspirasi Benda Asing pada Pasien Pediatrik wullur, caroline; Rasman, Marsudi
Majalah Anestesia dan Critical Care Vol 32 No 3 (2014): Oktober
Publisher : Perdatin Pusat

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Aspirasi benda asing adalah kejadian yang sering terjadi terutama pada populasi anak-anak. Kejadian ini dapat membahayakan nyawa sehingga diperlukan tindakan ekstraksi benda asing tersebut dengan segera. Diagnosis pasti dapat terhambat terutama bila dari anamnesa tidak spesifik, ketika orang tua tidak mampu menyadari pentingnya gejala, atau bahkan ketika temuan klinis dan radiologis tidak spesifik atau terlewatkan oleh dokter. Aspirasi bahan organik dapat menyebabkan peradangan mukosa saluran napas berat. Jika bahan organik tidak segera diekstraksi, peradangan kronis akan menyebabkan terbentuknya jaringan granulasi di sekitar benda asing, yang pada akhirnya dapat menyebabkan infeksi paru-paru, baik pneumonia maupun abses. Pada kejadian aspirasi benda asing, tidak jarang pasien datang dengan komplikasi sekunder, seperti demam terus-menerus, “asma”, atau pneumonia berulang untuk waktu yang lama. Pada tulisan ini akan diulas mengenai kejadian aspirasi-benda asing, berbagai samaran klinisnya, tata laksana ekstraksi dan anestesi yang tersedia, serta langkah-langkah yang dapat dilakukan untuk mencegah aspirasi. Kata kunci: Aspirasi, benda asing, bronkoskopi Foreign-body aspiration is a relatively common occurrence in children. It may present as a life-threatening event that necessitates prompt removal of the aspirated material. However, the diagnosis may be delayed when the history is atypical, when parents fail to appreciate the significance of symptoms, or when clinical and radiologic findings are misleading or overlooked by the physician. Aspiration of organic matter causes severe airway mucosal inflammation. If the organic matter is not promptly removed, chronic inflammation leads to the development of granulation tissue around the foreign body, which may ultimately present as a lung infection. In this setting, it is not uncommon to treat patients for secondary complications, such as persistent fever, “asthma,” or recurrent pneumonia for long periods. Here we review the incidence of foreign-body aspiration, its various clinical presentations, its management including anesthesia techniques, and measures we can do to prevent future aspirations. Key words: Aspiration, foreign body, bronchoscopy Reference Kalyanappago VT, Kulkarni NH, Bidri LH. Management of tracheobronchial foreign body aspirations in paediatric age group – A 10 year retrospective analysis. Indian J. Anaest 2007; 51(1): 20–23 Fidkowski C.W, Zheng H, Firth PG, The anaesthetic considerations of tracheobronchial foreign body in children: a literature review of 12.979 cases. Anaest Analg. 2010; 111(4): 1016–25 Roberts S and Thomington RE, Pediatric bronchoscopy. Contin educ anaesth crit care pain. 2005; 5 (2): 41 ̶ 44 Cote C, Lerman J, Anderson B. Otolaryngiologic procedure. Chapter 31 Page 657 ̶ 681. In: A practice of anesthesia for infants and children. 5th edition. Philadephia: Saunders Elsevier Publishing; 2013. Weir PM. Foreign Body Aspiration. Chapter 27, Pages 163–166. In: Problems in Anaesthesia: Paediatric Anaesthesia. Stoddart PA, Lauder GR (editors). London: Taylor and Francis Books Ltd; 2004 Naragund AI, Mudhol RS, Harugop AS, Patil PH, Hajare PS, Metgudmath VV. Indian J Otolaryngol Head Neck Surg. 2014; 66(S1): 180–5 A-Kader HH. Foreign body ingestion: children like to put objects in their mouth. World J Pediatr. 2010, 6(4): 301 ̶ 310 Seth D, Kamat D, Pansare M. Foreign body aspiration, a guide to early detection, optimal therapy. Consultant 360 for Pediatricians. 2007; 6(1) Farrell PT. Rigid Bronchoscopy for foreign body removal: anaesthesia and ventilation. Paediatric Anaesthesia 2005; 14: 84–89. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Pediatric Basic Life Support. Circulation. 2005;112:156–166
Co-Authors Boesoirie, M. Adli Budiana Rismawan Dewi Yulianti Bisri Ike Sri Redjeki Rasman, Marsudi Ruli Herman Sitanggang Tatang Bisri