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Jurnal Neuroanestesi Indonesia
ISSN : 20889674     EISSN : 24602302     DOI : https://doi.org/10.24244/jni
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.
Articles 277 Documents
Perbedaan Nilai The Clinic GBS Severity Evaluation Scale (CGSES) dan Skala Disabilitas Sindroma Guillain-Barre (SDSGB) pada Pasien Sindroma Guillian Barre dengan dan tanpa Imunoterapi Berliana Sidabutar; Ahmad Rizal Ganiem; Nushrotul Lailiyya; Nani Kurniani; Lisda Amalia; Sobaryati Sobaryati
Jurnal Neuroanestesi Indonesia Vol 10, No 2 (2021)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2999.551 KB) | DOI: 10.24244/jni.v10i2.328

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Latar Belakang dan Tujuan: The Clinical GBS Severity Evaluation Scale (CGSES) dikembangkan untuk penentuan imunoterapi pasien Sindroma Guillian Barre (SGB) secara lebih obyektif. Skala Disabilitas SGB (SDSGB) menggambarkan tingkat keparahan SGB dan dapat digunakan menilai efektifitas pemberian imunoterapi. Tujuan penelitian untuk mengetahui perbedaan penilaian CGSES dan SDSGB pasien SGB dengan dan tanpa imunoterapi dan membandingkan kesesuaian keputusan subyektif dengan CGSES. Subjek dan Metode: Penelitian observasional analitik potong lintang komparatif secara retrospektif pada pasien rawat SGB periode Januari 2015 – Maret 2020 di RSUP Dr Hasan Sadikin Bandung. Hasil: Terdapat 92 subjek (35 dengan dan 57 tanpa imunoterapi). Rerata usia 41,5 tahun, dengan pria:wanita (57,6%:42,4%). Tidak didapatkan perbedaan demografi dan pemeriksaan fisik kedua kelompok, kecuali paresis saraf kranial (62,9% vs. 33,3%; p=0,006). Terdapat perbedaan rerata lama perawatan dengan dan tanpa imunoterapi (29,5±34,4 vs. 11,4±4,1 hari, p=0,0001). Hasil penilaian CGSES pasien SGB dengan dan tanpa imunoterapi memiliki perbedaan bermakna (p=0,035). Terdapat perbedaan signifikan SDSGB saat masuk dan pulang pasien dengan imunoterapi (p=0,007) dan tanpa imunoterapi (p=0,025). Terdapat ketidaksesuaian keputusan subyektif dengan nilai CGSES (nilai Kappa 0,117; CI95% 0,021-0,213)Simpulan: Terdapat perbedaan skor CGSES dan SDSGB pada kelompok pasien SGB dengan dan tanpa imunoterapi. Terdapat ketidaksesuaian penilaian subyektif keputusan pemberian imunoterapi dengan skoring CGSES Differences in Value of The Clinic GBS Severity Evaluation Scale (CGSES) and Guillain-Barre Syndrome Disability Scale (GBSDS) in Guillian Barre Syndrome (GBS) Patients with and without ImmunotherapyAbstractBackground and objective: The Clinical GBS Severity Evaluation Scale (CGSES) was developed to determine immunotherapy of GBS patients more objectively. GBS Disability Scale (SDSGB) describes severity of GBS and assesses effectiveness of immunotherapy. Purpose of this study was to measure difference of CGSES and GBSDS in GBS patients with and without immunotherapy and to compare the suitability of subjective decisions with CGSES. Subject and Methods: This is a comparative cross-sectional analytic observational study retrospectively in GBS patients from January 2015-March 2020 hospitalized at Dr Hasan Sadikin Hospital, Bandung. Results: There were 92 subjects (35 with and 57 without immunotherapy). Mean age was 41.5 years, and male:female ratio was 57.6%:42.4%. There were no differences in demographics and physical examination between two groups, except for cranial nerve paresis (62.9% vs. 33.3%; p=0.006). There was a difference in mean length of stay with and without immunotherapy (29.5 ± 34.4 vs. 11.4 ± 4.1 days, p=0.0001). Results of the CGSES assessment with and without immunotherapy had a significant difference (p=0.035). There were significant differences in GBSDS at admission and discharge with (p=0.007) and without immunotherapy (p=0.025). There was a discrepancy between subjective decisions and CGSES value (Kappa value 0.117; 95% CI 0.021-0.213).Conclusion: There were differences in CGSES and GBSDS in group of GBS patients with and without immunotherapy. There was a discrepancy between subjective assessment of decision to give immunotherapy with CGSES scoring.
Penanganan Anestesi pada Operasi Olfactory Groove Meningioma Silmi Adriman; Dewi Yulianti Bisri; Sri Rahardjo; A Himendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2708.602 KB) | DOI: 10.24244/jni.vol4i1.108

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Angka kejadian Olfactory Groove Meningioma adalah 10–15% dari total meningioma yang terjadi di intrakranial, dimana tumor ini berasal dari basis cranii anterior. Manifestasi klinis berupa penurunan penciuman akibat terjepitnya saraf olfaktori dan apabila tumor cukup besar dan menekan saraf optikus, pasien akan mengalami penurunan penglihatan, bahkan buta. Pada kasus ini dilaporkan seorang wanita berusia 38 tahun, GCS 15 dengan diagnosis olfactory groove meningioma akan dilakukan operasi kraniotomi untuk pengangkatan tumor. Pasien datang dengan keluhan tidak bisa melihat dan tidak bisa mencium bebauan. Hasil CT Scan menunjukkan gambaran hiperdens berbentuk enhancing lesion pada regio frontal. Pasien dilakukan tindakan anestesi umum dengan intubasi. Induksi dengan propofol, fentanyl, lidokain dan vecuronium. Pengelolaan cairan perioperatif dengan ringerfundin, manitol dan furosemid. Pembedahan dilakukan selama 6 jam. Pasca bedah, pasien dirawat di Unit Perawatan Intensif (Intensive Care Unit/ ICU) selama 2 hari sebelum pindah ruangan. Anesthesia Management for Olfactory Groove Meningioma RemovalOlfactory Groove Meningioma, a type of meningioma is primarily derived from anterior cranial base, manifest in approximatelly 10-15% of meningioma cases. Clinical manifestations include smelling disorder and blurred vision or even cause blindness due to compression of the tumor to the optic nerve. This case reported a 38 years old woman with GCS 15 and diagnosed with olfactory groove meningioma, planned for a craniotomy tumor removal under general anesthesia. She was admitted to hospital due to blurred vision and smelling disorder. Computed Tomography (CT) scan showed a enhancing lesion in the frontal region. Induction of anesthesia was done using propofol, fentanyl, lidocaine and vecuronium. Ringerfundin, manitol and furosemide were used for perioperative fluid management. The surgery was conducted for 6 hours. Patient was managed in the Intensive Care Unit post operatively for 2 days prior to ward transfer
Pertimbangan Etika Klinik dan Medikolegal untuk Pengelolaan Anestesi pada Kasus Cedera Otak Traumatik Taufik Suryadi Ismail; Kulsum Kulsum
Jurnal Neuroanestesi Indonesia Vol 9, No 2 (2020)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (212.425 KB) | DOI: 10.24244/jni.v9i2.250

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Cedera Otak Traumatik (COT) merupakan penyebab utama kematian dan kesakitan pada anak-anak dan dewasa muda di seluruh dunia. Dilaporkan sebuah kasus COT pada seorang pasien anak laki-laki berusia 5 tahun yang jatuh dari lantai 2. Pasien didiagnosis dengan cedera kepala berat dengan perdarahan epidural dan subdural dengan level ASA 3–4. Dilema etis yang dihadapi ahli anestesi adalah tindakan anestesi berisiko tinggi tetapi kemungkinan penyelamatan nyawa tidak berhasil, sehingga apakah masih tetap dilakukan operasi atau hanya diberikan terapi suportif?. Laporan ini membahas tentang pemecahan dilema etik dan medikolegal berdasarkan teori etika klinik. Hasil pertimbangan etika dan medikolegal pada kasus ini dilakukan secara komprehensif dengan menghasilkan keputusan bersama antara tim dokter dengan keluarga pasien. Dengan pemberian informasi yang adekuat mengenai indikasi medik dengan tetap memperhatikan sudut pandang permintaan (keinginan) pasien, kualitas hidup maupun fitur kontekstual maka meskipun pada akhirnya pasien ini tidak berhasil diselamatkan, paling tidak keluarga pasien puas atas pelayanan yang telah diberikan. Clinical Ethics and Medicolegal Considerations for Anesthesia Management in Cases of Traumatic Brain InjuryAbstractTraumatic Brain Injury (COT) is a leading cause of death and illness in children and young adults throughout the world. A case of COT was reported in a 5-year-old boy who fell from the 2nd floor. The patient was diagnosed with a severe head injury with epidural and subdural bleeding with ASA levels 3-4. The ethical dilemma faced by the anesthesiologist is the high-risk anesthetic procedure but the possibility of life saving is unsuccessful, so whether the surgery is still being performed or only given supportive therapy?. This report discusses solving ethics and medicolegal dilemmas based on clinical ethics theory. The results of ethical and medicolegal considerations in this case were carried out comprehensively by producing a joint decision between the team of doctors and the patient's family. By providing adequate information regarding medical indications while still giving attention to the patients' preferences, quality of life and contextual features, even though these patients were ultimately unsuccessful, at least the patient's family was satisfied with the services provided.
Pengelolaan Anestesi untuk Evakuasi Hematoma Epidural pada Wanita dengan Kehamilan 22–24 Minggu Fitri Sepviyanti Sumardi; Nazaruddin Umar; Nancy Margareta Rehatta; Siti Chasnak Saleh
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2434.859 KB) | DOI: 10.24244/jni.vol5i2.67

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Tujuh sampai 8% dari seluruh wanita hamil pernah mengalami trauma yang dapat menyebabkan kematian ibu akibat traumanya, bukan akibat kehamilannya. Pengelolaan anestesi pada wanita hamil yang akan menjalani operasi dengan anestesi umum di luar seksio sesarea, terutama operasi bedah kepala, memberikan tantangan tersendiri kepada para ahli anestesi, karena terdapat 2 orang pasien yang harus dikelola agar menghasilkan nilai luaran klinis yang baik untuk keduanya. Kami akan melaporkan seorang wanita 22 tahun G1P0A0 dengan kehamilan 22–24 minggu, yang akan menjalani operasi evakuasi hematoma epidural akibat kecelakaan motor yang terjadi sebelumnya, tanpa dilakukan seksio sesarea, mengingatkan usia kehamilan masih dalam trimester kedua. Pertimbangan perubahan anatomi dan fisologis pada kehamilan, upaya agar aliran darah uteroplasenta adekuat serta efek teknik dan obat anestesi terhadap otak dan aliran darah uteroplasenta harus dipikirkan secara matang, karena faktor-faktor kritis akan menunjukkan derajat cedera kepala yang lebih berat, sehingga hasil nilai luaran klinis ibu dan janin buruk. Pada kasus ini ini ibu dapat pulang dengan kehamilan yang baik.Management of Anesthesia in Epidural Hematoma Evacuation with Pregnancy 22-24 WeeksSeven to 8% of pregnant women had experienced trauma that can lead to maternal deaths due to trauma not as result of her pregnancy. Management of anesthesia in pregnant women who will undergo surgery with general anesthesia outside caesarean section, especially neurosurgery, providing a challenge to the anesthesiologist, because there are two patients who must be managed in order to have good clinical score outcomes for both patients. We will report a 22-year-old woman who will undergo surgery epidural hematoma evacuation due to a motorcycle accident that occurred previously, without performed caesarean section, reminiscent of gestation is still in the second trimester. Consideration of anatomical and physiological changes in pregnancy and effort that uteroplacental blood flow should be considered carefully, because critical factors will indicate the degree of head injury more severe, so that the results of the clinical outcomes of mother and fetus is bad. In this case mother and her pregnancy can discharge from hospital with good condition.
Pengaruh Asam Traneksamat Intravena terhadap Jumlah Perdarahan Intraoperatif dan Kebutuhan Transfusi pada Operasi Meningioma Sigit Sutanto; Dewi Yulianti Bisri; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 8, No 1 (2019)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1585.173 KB) | DOI: 10.24244/jni.vol8i1.200

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Latar Belakang dan Tujuan: Meningioma merupakan tumor otak yang berisiko tinggi terjadi perdarahan pada reseksi massa. Penelitian dengan rancangan double blind RCT dilakukan pada 40 subjek meningioma di RSUP Dr Hasan Sadikin Bandung dengan tujuan melihat pengaruh asam traneksamat (TXA) dalam mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi. Subjek dan Metode: Subjek penelitian dibagi dua kelompok, kelompok A diberikan asam traneksamat intravena 20 mg/kg dalam NaCl 0,9% 100 mL dan kelompok B diberikan NaCl 0,9% 100 mL sebelum insisi. Data hemodinamik, jumlah cairan, jumlah transfusi dan jumlah perdarahan intraoperatif dicatat per jam. Dilakukan pemeriksaan kadar Hb, Ht dan faktor pembekuan pascaoperasi dan 24 jam pascaoperasi. Data hasil penelitian diuji secara statistik menggunakan uji t tidak berpasangan dan uji Mann-Whitney. Hasil: Perdarahan intraoperatif (1008,51±327,192 vs 1347±539,120 ml; p=0,021), kebutuhan pada transfusi packed red cell (PRC) intraoperatif (89,30±152,970 ml vs 306,85±224,631 ml; p=0,003), kebutuhan transfusi PRC 24 jam pasca operasi (88,50±153,014 ml vs 212,00±212,505 ml; p=0,028) pada kelompok A secara signifikan lebih kecil dari kelompok B.Simpulan: Asam traneksamat 20 mg/kg yang diberikan intravena sebelum insisi dapat mengurangi jumlah perdarahan intraoperatif dan kebutuhan transfusi pada operasi tumor otak suspek meningioma.Effects of Intravenous Tranexamic Acid on Blood Loss and Transfusion Requirements in Tumor Removal Surgery of Suspected MeningiomaBackground and objective: Meningiomas are highly vascular brain neoplasms that often associated with substantial blood loss. This experimental, double-blind RCT conducted in Dr. Hasan Sadikin Hospital, enrolled 40 subjects with intracranial meningioma underwent surgical excision. The objective of this study is to see the effect of tranexamic acid (TXA) in reducing bleeding and transfusion requirementsSubjects and Method: Subjects divided into two groups, group A received tranexamic acid 20 mg/kg body weight in 100 mL normal saline, and group B received 100 mL normal saline before incision. Intraoperative hemodynamics, amount of fluid, transfusions, and blood loss were recorded hourly. Hemoglobin, hematocrit, and coagulation factors measured in postoperative, and subjects were followed up for the first 24 hours to record transfusion requirements and laboratorium work up. We analyzed the data using t-test and Mann-Whitney test. Results: Intraoperative blood loss (1008,51±327,192 vs 1347±539,120 ml; p=0,021), intraoperative packed red cell (PRC) transfusion requirement (89,30±152,970 ml vs 306,85±224,631 ml, p=0,003), PRC transfusion requirement in first 24 hours postoperative (88,50±153,014 ml vs 212,00±212,505 ml, p=0,028) in group A significantly less than group B Conclusions: Administration of intravenous tranexamic acid 20 mg/kg before incision can reduce intraoperative blood loss and transfusion requirement in patients underwent surgical excision of meningioma
Konsep Dasar Target Controlled Infusion (TCI) Propofol dan Penggunaannya pada Neuroanestesi Ida Bagus Krisna J. Sutawan; I Putu Pramana Suarjaya; Siti Chasnak Saleh; A. Himendra Wargahadibrata
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (410.686 KB) | DOI: 10.24244/jni.vol6i1.40

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Semakin banyaknya dokter anestesi yang cendrung memilih total intravenous anesthesia (TIVA) terutama untuk operasi bedah saraf, merangsang munculnya sebuah penemuan baru yang dapat menghitung dan memperkirakan kadar obat anestesi di dalam plasma dan target organ yang selanjutnya dikenal dengan Target-controlled Infusion (TCI). Jika obat yang digunakan adalah propofol maka dikenal dengan TCI propofol. Ada dua model yang saat ini tersedia secara komersial untuk TCI propofol yaitu model Marsh dan model Schnider. Untuk dapat dengan baik menggunakan kedua model tersebut diperlukan pengetahuan yang mendalam mengenai konsep farmakokinetik tiga kompartemen dan farmakodinamik yang menjadi dasar dalam penghitungan dosis propofol pada kedua model tersebut. Jika menggunakan model Marsh maka disarankan untuk menggunakan target plasma, sedangkan  pada model Schneider sebaiknya digunakan target effect. TCI propofol yang digunakan dengan baik dapat memberikan keadaan anestesi yang hemodinamiknya relatif stabil pada saat induksi dan pemeliharaan, penurunan angka penekanan respirasi, dan peningkatan waktu pemulihan. Basic Consept on Targeted-controlled Infusion (TCI) Propofol and its use in NeuroanesthesiaThere is increasing number of anesthesiologist who prefer to use total intravenous anesthesia especially neurosurgery, stimulate new invention that can calculate and predict drug concentration in plasma and target organ, that have known as Target-Controlled Infusion (TCI). If propofol is used, it is known as TCI propofol. There are two kind of TCI propofol modes that provided commercially, that are Marsh mode and Schnider mode. Understanding the different between those two modes needs knowleadge about pharmacokinetic of the three compartement models and pharmacodynamic which is the base of the calculation of the propofol dose. If Marsh mode is used, than it is suggested to use it in plasma target, however if the Schnider mode is used, than it is suggested to use it in target effect. TCI propofol, which is used in good manner can provide an anesthesia with relatifly stable haemodinamic on induction and maintenance, decrease respiratory depression and increase recovery time.
Penatalaksanaan Anestesi pada Pasien dengan Sindroma Apert yang Dilakukan Suturektomi Iwan Abdul Rachman; Iwan Fuadi; Eri Surahman
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (345.332 KB) | DOI: 10.24244/jni.vol2i2.161

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Sindroma Apert adalah suatu gangguan genetik yang ditandai dengan penggabungan tulang yang terlalu dini (kraniosinostosis). Penggabungan dini tersebut menghambat pertumbuhan normal tulang dan mempengaruhi pertumbuhan bentuk kepala dan wajah. Penggabungan dini tulang kepala dapat mempengaruhi perkembangan otak bahkan menyebabkan peningkatan tekanan intrakranial, dan pada sindroma Apert juga didapatkan penggabungan beberapa jari tangan dan kaki (sindaktili). Seorang anak berusia 2 tahun dengan sindroma Apert. Tanda klinis peningkatan tekanan intrakranial belum didapatkan sehingga operasi dijadwalkan terencana dan pasien dirawat terlebih dahulu di ruangan. Kemungkinan kesulitan untuk intubasi dengan laringoskopi diantisipasi dengan persiapan intubasi menggunakan optik fiber dan trakeostomi. Pasien diberikan premedikasi midazolam 0,5 mg intravena pada saat pasien akan dibawa ke kamar operasi. Dilakukan anestesi umum, induksi menggunakan propofol 30 mg, fentanil 30 μg diberikan 3 menit sebelum intubasi. Fasilitas intubasi dengan vekuronium 2 mg, pemeliharaan anestesi dengan N2O/O2 dan Sevofluran. Vekuronium diberikan 1 mg /jam. Ventilasi kendali menggunakan ETT no. 5,0. Operasi berlangsung selama 6 jam dengan posisi pasien terlentang. Hemodinamik selama operasi relatif stabil, tekanan darah sistolik berkisar 90-110 mmHg, tekanan darah diastolik 50-70 mmHg, laju nadi (HR) 87-110 x/mnt, SaO2 99-100 %. Setelah operasi berakhir pasien bernafas spontan adekuat dan dilakukan ekstubasi di kamar operasi. Pasca operasi pasien di rawat di PICU hingga hari ke-4 pasien dipindahkan ke ruangan. Gangguan penggabungan tulang kepala yang terlalu dini dapat menyebabkan gangguan pertumbuhan bentuk kepala, otak dan gangguan pendengaran dan penglihatan. Selain itu juga dapat menyebabkan terjadinya peningkatan tekanan intrakranial. Koreksi segera dengan melakukan suturektomi dan dekompresi dapat mencegah kemungkinan-kemungkinan tersebut. Anaesthetic management of patient with Apert syndrome which undergo suturectomy Apert syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. Early fusion of the skull bones also affects the development of the brain and even can increased the intracranial pressure. In apert syndrome there was also fusion of fingers and toes (syndactyly). A 2 years old child with Apert syndrome which undergo suturectomy and decompression. The clinical signs of raised intracranial pressure in this patient has not been obtained yet so the surgery was done as scheduled . Difficulties to perform intubation with direct laryngoscopy were anticipated through the use of fiber optic and preparation of tracheostomy. Patient has been given premedication using midazolam 0,5 mg given intravenously before his admission to the operating room. The surgery is performed with general anesthesia using propofol 30 mg then fentanyl 30mcg, 3 minutes before intubation. Vecuronium 2mg was given to facilitates intubation. Maintenance of anesthesia with Nitroons/O2 sevoflurane and Vecuronium 1mg/hour. Ventilation was controlled by using ETT no 5.0. Patient was in supine position, and it last for 6 hours. There was relatively stable hemodynamics, systolic blood pressure range 90-110 mmHg, diastolic blood pressure 50-70 mmHg, pulse rate 87-110x/minutes, SaO2 99-100%. After the operation, there was adequate spontaneous breathing so extubation was performed in the operating room, then he was referred to PICU. On day 4 patient was moved to the room. Premature fusion of skull bones will cause growth disorders of the head, brain, and hearing and vision impairment. It also can cause increased intracranial pressure. Immediate correction by suturectomy and decompression can prevent this possibility.
Penurunan Kadar Glutamat pada Cedera Otak Traumatik Pascapemberian Agonis Adrenoseptor Alpha-2 Dexmedetomidin sebagai Indikator Proteksi Otak MM Rudi Prihatno; M. Sofyan Harahap; Ieva B Akbar; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (380.859 KB) | DOI: 10.24244/jni.vol3i2.138

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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.
Penggunaan Calcium Channel Blocker pada Tatalaksana Anestesi Clipping Aneurisma Otak Fanda Ayyu Rindiati; Himawan Sasongko; M Sofyan Harahap
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2754.016 KB) | DOI: 10.24244/jni.v8i3.232

Abstract

Perdarahan subarachnoid dapat diartikan sebagai proses pecahnya pembuluh darah di ruang yang berada dibawah arakhnoid (subarachnoid). Prevalensi terjadinya perdarahan subaraknoid dapat mencapai hingga 33.000 orang per tahun di Amerika Serikat. Penyebab paling sering perdarahan subarachnoid adalah ruptur aneurisma salah satu arteri di dasar otak dan adanya malformasi arteriovena (MAV). Pada umumnya aneurisma terjadi pada sekitar 5% dari populasi orang dewasa, terutama pada wanita. Penanganan pada aneurisma pembuluh darah otak salah satunya dengan clipping aneurisma. Tindakan tersebut beresiko terjadi vasospasme serebral. Nimodipine adalah suatu calcium chanel blocker yang penting dalam pengelolaan operasi aneurisma karena mempunyai efek vasodilatasi pembuluh darah serebral dan termasuk dalam bagian dari manajemen vasospasme serebral. Pada laporan ini, dilaporkan dua kasus tindaan clipping aneurisma. Pasien pertama adalah wanita usia 69 tahun, berat badan 60 kg dengan diagnosa SAH hari ke 18 yang mengalami defisit neurologi berupa hemiparese dextra dan afasia motorik. Pasien kedua adalah wanita usia 57 tahun berat badan 60 kg dengan diagnosa SAH hari ke 20 dan mengalami defisit neurologi hemiparese kanan dan afasia sensorik. Pada kedua pasien dilakukan tindakan pembedahan kraniotomi clipping aneurisma. Kedua pasien memiliki hasil akhir yang baik. Akan tetapi, ada perbedaan lama perawatan antara pasien yang menjalani terapi awal nimodipine dan yang tidak menerima terapi tersebut.Administration of Calcium Channel Blocker in Anaesthesia Management of Cerebral Aneurysm ClippingAbstractSubarachnoid hemorrhage can be interpreted as the process of rupture of blood vessels in the space under the arachnoid (subarachnoid). The prevalence of subarachnoid hemorrhage can reach up to 33,000 people per year in the United States. The most common causes of subarachnoid bleeding are ruptured aneurysm in one of the arteries at the base of the brain and the presence of arteriovenous malformations (MAV). In general, aneurysms occur in about 5% of the adult population, especially in women.Therapy in cerebral vascular aneurysms, one of which is clipping aneurysms. These actions are at risk of cerebral vasospasm. Nimodipine is a calcium channel blocker which is important in the management of aneurysm surgery because it has a vasodilating effect on cerebral vessels and is included in the management of cerebral vasospasm. In this report, two cases of clipping aneurysm are reported. The first patient was a woman aged 69 years, body weight 60 kg with a diagnosis of SAH day 18 who had a neurological deficit in the form of hemiparese dextra and motor aphasia. The second patient was a 57-year-old woman weighing 60 kg with a diagnosis of SAH day 20 and had a neurological deficit in the form of right hemiparese and sensory aphasia. In both patients, clipping aneurysm was performed by craniotomy surgery. Both patients had good results. However, there is a difference in the length of stay between patients who underwent initial nimodipine therapy and who did not receive it.
Penatalaksanaan Anestesi pada Pembedahan Akustik Neuroma dengan Monitoring Saraf Kranialis Sandhi Christanto; I Putu Pramana Suarjaya; Sri Rahardjo
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
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Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (3198.439 KB) | DOI: 10.24244/jni.vol5i1.59

Abstract

Tumor di daerah Cerebello pontine Angle (CPA) mencakup kurang lebih 10% dari seluruh angka kejadian tumor primer intrakranial pada orang dewasa. Sebagian besar kasus tumor CPA (80–90%) adalah akustik neuroma dan sisanya berupa meningioma, epidermoid, kista arakhnoid dan lain sebagainya. Akustik neuroma bersifat jinak namun dapat mengancam jiwa karena lokasinya yang berdekatan dengan struktur- struktur vital di daerah CPA. Pengelolaan anestesi pasien dengan neuroma akustik perlu memperhatikan pertimbangan-pertimbangan seperti lokasi tumor yang berdekatan dengan struktur vital, posisi operasi dan risiko yang dapat ditimbulkan, risiko emboli udara selama tindakan operasi, gangguan hemodinamik akibat manuver pembedahan di regio infratentorial dan monitoring neurofiologis selama operasi untuk mencegah kerusakan saraf kranial didaerah tersebut. Wanita 46 th, berat badan 48 kg diagnosa tumor CPA kanan, dengan diagnosa banding akustik neuroma dan meningioma. Pasien mengeluh telinga kanan berdenging dan pendengaran menurun sejak 1 tahun yang lalu namun keluhan dan gejala neurologis lain tidak didapatkan. Pemeriksaan MRI didapatkan massa di daerah CPA dextra ukuran 2,2 x 1,2 x 2,2 cm yang mendesak saraf kranial V ke supero-medial. Tindakan pembedahan dengan monitoring saraf kranialis diperlukan untuk mengambil tumor dengan meminimalkan risiko kerusakan pada saraf kranialis yang ada disekitar tumor tersebut. Tujuan dari laporan kasus ini adalah membahas pengelolaan pasien yang dilakukan pembedahan di daerah CPA dan pertimbangan-pertimbangan anestesi yang berkaitan dengan tehnik diatas.Surgery Anesthesia Management on Acoustic Neuroma with Cranial Nerves MonitoringCerebellopontine angle tumor represent 10% of all adult primary intracranial tumor. Most common form of CPA tumor (80–90%) is acoustic neuroma and the rest are meningiomas, epidermoid, arachnoid cyst and many others. Although acoustic neuroma is benign lesion, this tumor can bring threat to life because the complex anatomy and important neurovascular structures that traverse this space. Like all posterior fossa surgery, perioperative considerations of acoustic neuroma management related to anatomical complexity, patient positioning, the potential for venous-air embolism, brainstem dysfunctions, hemodynamic arousal caused by surgical maneuver and intraoperative neurophysiologic monitoring. A 46 years old woman, 48kg was diagnosed with right CPA tumor with differential diagnose between acoustic neuroma and meningioma. She complained of gradual loss of hearing in right ear and associated with tinnitus . Other neurologic defisit was not found. Right CPA mass, 2,2 x 1,2 x 2,2 cm size with pressure over fifth cranial nerve to supero-medial region was found in MRI examination. Surgical approach with intraoperative neuromonitoring need to be done in order to resect tumor while minimizing risk of cranial nerve injury. The purpose of this case report is to discuss management patient with CPA tumor and its anestetic considerations which are connected to the procedure.

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