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Jurnal Neuroanestesi Indonesia

jni
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Published by Indonesian Society of Neuroanesthesia & Critical Care

ISSN : 20889674 EISSN : 24602302 DOI : https://doi.org/10.24244/jni

Core Subject : Health, Science, Education,

Biochemistry, Genetics & Molecular Biology Education Medicine & Pharmacology Neuroscience Public Health

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.

Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine

Articles 309 Documents

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Manajemen Anestesi pada Pasien dengan Akromegali yang Menjalani Prosedur Reseksi Tumor Adenohipofise melalui Pendekatan Sublabial Transphenoidal Hamzah Hamzah; Muhammad Farris; Yoppie Prim Avidar; Nancy Margaritta Rehatta
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Akromegali merupakan penyakit akibat produksi growth hormone secara berlebihan dan umumya disebabkan oleh adenoma kelenjar hipofisis. Insidensi akromegali pertahunnya mencapai 5 kasus per 1 juta orang dengan prevalensi 60 kasus per 1 juta orang. Manifestasi klinis pada tiap pasien berbeda, tergantung dari kadar dari growth hormone, insulin-like growth factor-1, usia pasien, ukuran tumor, dan keterlambatan diagnosis. Pasien dengan akromegali telah dilaporkan memiliki tingkat mortalitas dan morbiditas yang tinggi, peningkatan angka kematian pada umumnya terkait dengan komplikasi kelainan kardiovaskular, serebrovaskular dan masalah respirasi. Pada kasus ini, seorang laki-laki usia 57 tahun, berat badan 86 kg, dengan PS-ASA II, perawakan khas akromegali dan ditunjang dengan hasil pemeriksaan hormon. Pada pemeriksaan CT-scan ditemukan massa di ruang sella tursica. Pemeriksaan lebih lanjut menunjukkan pembesaran lidah yang menimbulkan kesulitan manajemen jalan nafas dan diklasifikasikan sebagai mallampati kelas II. Pasien akan dilakukan prosedur reseksi tumor adenohipofise melalui pendekatan sublabial transpheonidal dengan anestesi umum. Sebagian besar anestesi untuk operasi pada pasien akromegali membutuhkan perhatian khusus dibandingkan dengan tumor kepala yang lain.Anesthesia Management in Patients with Acromegaly Underlying Adenohipofise Tumor Resection Procedures Through a Transphenoidal Sublabial ApproachAcromegaly and gigantism are clinical abnormalities due to excessive growth hormone production, usually resulted from pituitary adenoma. The incidence of acromegaly is 5 cases per 1 million people per year while the prevalence is 60 cases per 1 million people. Clinical manifestations in each patient is depending on the levels of growth hormone, insulin-like growth factor-1, age of the patient, tumor size and the delay in diagnosis. Increased of morbidity and mortality have been reported in acromegaly patients predominantly caused by complications of cardiovascular, cerebrovascular and respiratory problem. A 57 year old male, 86 kgs, ASA physical status II. His appearance suggested acromegaly, diagnosis then confirmed with hormonal examination and imaging of the pituitary mass. Further examination presented tongue enlargement which cause airway management difficulty and classified as mallampati class II. The patient will undergo adenohipofise tumor resection procedures through a transphenoidal sublabial approach with general anaesthesia. Most of anaesthesia in acromegaly patient surgery require special attention compared with other head tumors.

Anestesia pada Tindakan Dekompresi Foramen Magnum pada Pasien dengan Malformasi Arnold Chiari Nazaruddin Umar; Haryo Prabowo; Tasrif Hamdi
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Malformasi Arnold Chiari tipe 1 adalah pergeseran tonsil serebellum kearah kaudal kanalis spinalis tulang belakang servikal melalui foramen magnum. Siringomielia adalah gangguan degeneratif progresif yang ditandai dengan amiotropi brakhial dan kehilangan fungsi sensorik dan secara patologi dengan kavitasi bagian sentral dari medula spinalis, siringomielia pada malformasi Chiari terjadi antara level servikalis 4–6. Seorang laki-laki usia 29 tahun datang dengan riwayat nyeri tumpul di kedua lengan atas. Dalam perjalanannya setelah 2 tahun terjadi atropi thenar dan hipothenar dan kehilangan kemampuan motorik pada kedua lengan atas. Pemeriksaan neurologis menunjukkan gangguan sensorik pada lengan kanan dan lengan kiri. Pencitraan MRI menunjukkan herniasi tonsil ke foramen magnum dan siringomielia dari medula oblongata ke level T4. Laporan kasus ini adalah kasus langka seorang laki-laki dengan malformasi Arnold Chiari tipe 1 dengan manifestasi lambat dan siringomielia yang sukses menjalani prosedur operasi dekompresi foramen magnum dengan teknik anestesi umum. Anesthesia for Foramen Magnum Decompression in Patient with Arnold Chiari Malformation The Arnold Chiari malformation type I (Chiari malformation) is a caudal displacement of the cerebellar tonsils into the cervical spinal canal through the foramen magnum. Syringomyelia is a chronic progressive degenerative disorder characterized clinically by brachial amyotrophy and segmental sensory loss of dissociated type, and pathologicaly by cavitation of the central parts of the spinal cord, syringomyelia is often associated with Chiari Malformation type I and is commonly seen between the C-4 and C-6 levels. A 29-year-male had experienced a history of dull pain in her both arm for 2 years. Additionally, after two years hipothenar and thenar muscle became atropi and the patient lossing his upper extremity motorik ability. The neurological examination revealed sensory disturbances in his right arm,and left arm. MRI showed cerebellar tonsillar herniation into the foramen magnum and syringomyelia from the medulla oblongata to the T4 level. This report is a very rare case of an middle age male with late-onset Arnold Chiari malformation type I and syringomyelia that was successfully undergo foramen magnum decompression under general anesthesia.

Manajemen Anestesi pada Pasien Sindroma Kauda Equina e.c. SOL Ekstrameduler Intradural dengan Kehamilan Ferra Mayasari; Tubagus Yuli R; Iwan Fuadi
Jurnal Neuroanestesi Indonesia Vol 3, No 1 (2014)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Manajemen anestesi untuk pasien hamil untuk operasi non-obstetrik jarang dilakukan, dan menimbulkan sejumlah tantangan bagi spesialis anestesiologi karena manajemen anestesi harus mempertimbangkan kehidupan ibu dan janin. Pertimbangan anestesi untuk wanita hamil dengan operasi non obstetri meliputi perubahan kardiovaskular dan hematologi, sistem respiratori, sistem gastrointestinal, dan sistem saraf pusat serta perifer serta pada kasus ini adalah posisi yang ekstrim. Seorang wanita berusia 26 tahun dengan sindroma kauda equina e.c. SOL ekstramedula intradural dengan G3P2A0 gravida 25‒26 minggu yang dilakukan tindakan laminektomi pengangkatan tumor dalam anestesi umum dengan posisi miring kekiri. Operasi dapat dilaksanakan tanpa adanya komplikasi, pascaoperasi baik ibu maupun janin dalam keadaan sehat. Keberhasilan manajemen anestesi pada operasi non-obstetrik selama kehamilan tergantung kepada kerjasama multidisiplin, penilaian preoperatif yang komprehensif, perhatian terhadap fisiologi maternal dan fetus, serta perawatan suportif periode postoperatif. Mempertahankan stabilitas maternal, waktu optimal melakukan tindakan, dan pemilihan obat serta teknik anestesi yang tepat merupakan hal yang sangat penting diperhatikan untuk keamanan ibu dan fetus. Anesthesia Management of Pregnant Patient with Cauda Equine Syndrome e.c. Extramedulary Intradural SOLAnesthesia management for non-obstetric surgery during pregnancy is relatively uncommon and challenges the anesthesiologist since anesthesia management must consider both mother and fetal safety. Anesthesia management for non-obstetric pregnant women is considered covering difference in cardiovascular and hematologic changes, respiratory system, gastrointestinal system, central nervous system and peripheral nervous system, and in this case extreme position for operation. For this case, a 26 year old woman with Cauda Equina Syndrome e.c. Extramedullary Intradural SOL with G3P2A0 25‒26 weeks pregnancy underwent Laminectomy for Tumor Removal under general anesthesia. The surgery was preceded without any complication, both mother and fetal recovered uneventfully. The successful of anesthesia management for non-obstetric surgery during pregnancy depends on multidisciplines coordination, comprehensive preoperative management, careful monitoring on maternal and fetal physiology, and supportive postoperative care. Maintaining maternal stability, determination of the optimal time for surgery, and selection of proper medication and anesthesia technique are the most important things to be considered for mother and fetal safety.

Hypoxia Inducible Factor (HIF) 1-Α dan Vascular Endothelial Growth Factor (VEGF) pada Stroke Iskemik Fase Akut Lisda Amalia; Ida Parwati; Ahmad Rizal; Ramdan Panigoro; Uni Gamayani; Al Rasyid; Nur Atiik
Jurnal Neuroanestesi Indonesia Vol 8, No 3 (2019)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Stroke iskemik merupakan salah satu penyebab stroke tersering, disebabkan oleh oklusi pembuluh darah serebral dan penyebab kematian ketiga. Saat awitan stroke iskemik terjadi, area otak yang diperdarahi oleh pembuluh darah akan kekurangan oksigen dan nutrisi sehingga sel otak terutama neuron berada dalam risiko, neuron ini masih dapat berfungsi yang dikenal sebagai penumbra. Hipoksik, salah satu karakteristik penumbra merupakan stimulus utama regulasi protein HIF-1α. Hipoksik sendiri merupakan stimulus utama prekondisi iskemik. Prekondisi iskemik akan menghasilkan fenotipe tahan hipoksia yakni protein hypoxia inducible factor (HIF)-1α. HIF-1α merupakan satu-satunya zat yang dikeluarkan oleh jaringan yang mengalami hipoksia. HIF-1α bertindak sebagai protein sinyal yang dapat meregulasi gen protein lain. Efektor HIF-1α antara lain eritropoitin dan vascular endothelial growth factor (VEGF). Pertumbuhan, diferensiasi dan ketahanan sel endotel diregulasi oleh VEGF yang distimulasi dari HIF-1α. Selama iskemik serebral, jaringan yang rusak mencoba untuk meningkatkan pengiriman oksigen melalui induksi angiogenesis melalui produksi VEGF. Hal ini ditandai dengan adanya peningkatan jumlah pembuluh-pembuluh darah mikro di area infark. VEGF dan reseptornya diregulasi oleh HIF-1α dalam hari pertama iskemik.Hypoxia Inducible Factor (HIF) 1-Α and Vascular Endothelial Growth Factor (VEGF) in Acute Ischemic StrokeAbstractIschemic stroke is one of the most common causes of stroke, caused by cerebral vascular occlusion and the third cause of death. When the onset of an ischemic stroke occurs, the area of the brain bleeding by blood vessels will lack oxygen and nutrients so that brain cells, especially neurons, are at risk, these neurons can still function known as penumbra. Hypoxic, one of the characteristics of penumbra is the main stimulus for regulation of HIF-1α protein. Hypoxia itself is the main stimulus of ischemic precondition. The ischemic precondition will produce a hypoxic-resistant phenotype namely protein hypoxia inducible factor (HIF) -1α. HIF-1αis the only substance released by tissue that experiences hypoxia. HIF-1α acts as a signaling protein that can regulate other protein genes. Effectors of HIF-1αinclude erythropoitin and vascular endothelial growth factor (VEGF). Growth, differentiation and endurance of endothelial cells are regulated by VEGF stimulated from HIF-1α. During cerebral ischemia, damaged tissue tries to increase oxygen delivery through induction of angiogenesis through VEGF production. This is characterized by an increase in the number of micro blood vessels in the infarct area. VEGF and its receptors are regulated by HIF-1α in the first day of ischemia.

Penggunaan FOUR Skor dalam Manajemen Anestesi untuk Evakuasi Hematoma Epidural pada Pasien dengan Intoksikasi Alkohol Riyadh Firdaus; Diana C. Lalenoh; Sri Rahardjo; Tatang Bisri
Jurnal Neuroanestesi Indonesia Vol 6, No 3 (2017)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Manajemen neuroanestesia untuk cedera kepala bertujuan untuk mengoptimalkan perfusi otak, memfasilitasi pembedahan dan mencegah cedera otak sekunder. Bagi pasien cedera kepala yang mengalami toksisitas alkohol, diperlukan perhatian khusus dalam mengevaluasi dan menentukan dosis obat anestesia. Walaupun GCS dapat digunakan sebagai modalitas penilaian pasien dengan intoksikasi alkohol, penilaian menggunakan FOUR adalah alternatif yang lebih baik. FOUR lebih spesifik dalam menilai penurunan kesadaran bila ada defek neurologi, bahkan bagi pasien yang terintubasi. Selama pembiusan, dosis perlu diperhatikan karena konsumsi alkohol jangka panjang dapat meningkatkan kebutuhan dosis obat anestesia. Sebaliknya, intoksikasi alkohol memerlukan dosis obat induksi yang lebih kecil. Seorang laki-laki usia 38 tahun dibawa ke IGD dengan penurunan kesadaran pasca trauma kepala sejak 3 jam sebelum masuk rumah sakit. Pasien memiliki riwayat konsumsi alkohol. Berdasarkan anamnesis, pemeriksaan fisis dan pemeriksaan penunjang, ditegakkan diagnosis Hematom Epidural. Pasien menjalani kraniotomi evakuasi Hematom Epidural selama 4 jam. Pascaoperasi pasien tidak dilakukan ekstubasi dan dirawat di perawatan ICU selama 7 hari.Use of Four Score in Anesthesia Management for Epidural Hematoma Evacuation in Patient with Alcohol IntoxicationNeuroanesthetic management for brain trauma aims to maintain optimal cerebral perfusion and facilitate surgery while preventing secondary brain injury. For patients with brain trauma under alcohol toxicity, careful monitoring is needed to assess and determine drug dosing. Although GCS is reliable for assessing conciousness in patients with alcohol intoxication, evaluation using FOUR is a reasonable alternative. FOUR is more spesific in identifying level of conciousness in neurologic defects, even in intubated condition. Throughout anesthesia, special attention should be given, as long term alcohol consumption may increase the dose needed for general anesthesia. However, a smaller dose of induction agent is needed in alcohol intoxication. We describe a case of a 38 years old male, who was admitted to emergency department with loss of conciousness following head trauma for 3 hours prior to admission. There was history of alcohol consumption. History and physical findings were consistent with epidural hematoma. Patient underwent craniotomy for epidural hematoma evacuation. The surgery took four hours. Post surgery, patient remained intubated and stayed in ICU for seven days.

Subdural Empiema L1-5 Pasca Anestesi Anestesi Neuraksal M. Jalaludin A. Chalil; Nazaruddin Umar
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Komplikasi infeksi dapat saja terjadi setelah tehnik anestesi regional apapun, namun hal ini menjadi perhatian yanga sangat penting ketika infeksi terjadi disekitar medulaspinalis atau di dalam kanalis spinalis. Infeksi bakteri pada medulla spinalis dapat berupa meningitis atau penekanan medulla yang sekunder terhadap pembentukan abses. Sumber infeksi dapat berasal dari kolonisasi kuman yang jauh atau dari infeksi pada tempat insersi, yang menyebar secara hematogen dan menginvasi ke system saraf pusat. Seorang wanita 35 tahun dengan berat badan 55 kg, dating ke RSUP H. Adam Malik Medan dengan keluhan utama kedua tungkai tidak dapat diogerakkan, yang dialami pasien sejak lebih kurang 2 minggu sebelum masuk ke rumah sakit. Sekitar 2 bulan sebelumnya, pasien ini menjalani operasi melahirkan dengan tindakan pembiusan spinal di rumah sakit lain. Seminggu kemudian, dia merasakan nyeri pinggang terutama disekitar tempat suntikan disertai adanya demam. Keluhan ini berlanjut dengan dirasakannya nyeri yang menjalar dari pinggang ke kedua tungkai diikuti dengan rasa kebas dan kesemutan, kemudia tidak dapat digerakkan lagi. Pasien ini juga mengeluhkan beser buang air besar dan buang air kecil. Tidak ada riwayat penurunan kesadaran, kejang, dan muntah menyembur pada pasien ini. Juga tidak didapati adanya riwayat terjatuh, Dari pemeriksaan fisik, laju nafas 18 x/menit, regular, suara pernafasan vwsikuler, suara tambahan tidak dijumpai, tekanan darah 130/80 mmHg, laju nadi 88 x/menit, regular, temperature 37,8 0C. Kesadaran composmentis, dengan paraplegia pada kedua tungkai, paraestasia (+). Pemeriksaan laboratorium : Hb: 10,3 g%, Ht: 32,4%, leukosit: 24.900/mm3. MRI: dijumpai adanya gambaran abses, Dilakukan anestesi umum posisi telungkup, pasien menjalani tindakan laminektomi untyk evakuasi abses. Durante operasi dijumpai adanya pus sekitar 40 ml di daerah subdural L1 sampai L5. Kultur pus: dijumpai Staphylococcus epidermidis. Selanjutnya pasien dirawat di ICU pascabedah dan diberikan terapi antibiotik meropenem 1 gram per 8 jam, metronidazole 1500 mg per hari, gentamisin 80 mg per 12 jam. Pasca operasi sampai pasien pulang, tidak dijumpai adanya perbaikan yang siognifikan. Namun demikian dijumpai adanya pengurangan keluhan berupa hilangnya demam, nyeri pinggang, serta hilangnya nyeri pada kedua tungkai dengan perbaikan fungsi motorik dari 0 menjadi 2.Empyema Subdural L1-5 After Neuraxial AnesthesiaInfectious complications may occur after any regional anesthetic techniques, but are of greatest concern if the infection occurs around the spinal cord or within the spinal canal. Bacterial infection of the central neural axis may present as meningitisor cord compression secondary to abscess formation. The infectious source for meningitisand epidural abscess may result from distant colonization or localized infection with subsequent hematogenous spread and central nervous system (CNS) invasion. A woman 35-year old weight 55kg, came into RSUP H. Adam Malik Medan with the main complaint can not be moved both legs, since approximately 2 weeks before entering the hospital, where previously she was performed to caesarean section with spinal anesthesia techniques, a week later she was feeling numb and tingling feer, then can not moved anymore, She alspo complained incontinensia of defecation and urination, History offever (+), low back pain (+). A history of trauma (-). From physical examination, breath rate 18 c/min, regular, vesicular breathing sounds, extra sounds not found, blood pressure 140/90 mmHg, heart rate 100 x/min, regular, temperature 37.80C.mAwareness is compomentis, with paraplegia in both legs, paraestesia (+). Laboratory tests: Hb: 10.3g%, Ht: 32.4%, leukocytes: 24.900/mm3, platelet 496.000/mm3. MRI: found a picture of an abscess, By general anesthesia with prone position, the patient underwent debridement laminectomy for evacuation of abscess, Durante operation encountered about 40ml of pus in the subdyral L1 to L5. Furthermore, patients trated in the ICU after surgery and antibiotic therapy meropenem 1 gram per 8 hours, metronidazole 1500mgday, gentamicin 80mg per 12 hours was given. During post operative care until the patient discharge from hospital, there were no improvement significantly, howefer, there were reducing in low back pain, fever, and loss of pain in both legs with improved motor function from 0 to 2.

Talaksana Perioperatif Pasien dengan Reseksi Arteriovenous Malformation Intrakranial Endah Permatasari; Bambang J. Oetoro; Syafruddin Gaus
Jurnal Neuroanestesi Indonesia Vol 7, No 1 (2018)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Tindakan pembedahan eksisi arteriovenous malformation (AVM) merupakan salah satu prosedur yang menantang di bidang neuroanestesia. Diagnosis AVM ditegakkan berdasarkan gejala klinis didukung pemeriksaan neuroradiologis. Untuk persiapan perioperatif pasien AVM yang optimal, ahli anestesi harus memahami patofisiologi AVM dan tatalaksananya. Terapi pada pasien AVM sangat tergantung pada ukuran diameter AVM dan lokasinya. Target utama dari operasi adalah memotong pasokan aliran darah ke AVM. Dengan tindakan reseksi AVM, bila AVM sudah dapat diidentifikasi maka pasokan aliran darah akan dihentikan dan dilakukan pengangkatan nidus. Pada kasus ini dilaporkan seorang wanita usia 19 tahun dengan nilai GCS 15, BB 59 kg, datang dengan keluhan sering sakit kepala semenjak 1 tahun sebelum masuk RS. Hasil angiografi otak menunjukan adanya gambaran AVM di lobus parietal kanan. Dilakukan tindakan reseksi AVM dan pembedahan berhasil dengan baik. Tidak timbul defisit neurologis pascabedah. Pascabedah pasien dirawat di ICU dan pindah keperawatan keesokan harinya.Perioperative Management Patient with Intracranial Arteriovenous Malformation ResectionArteriovenous malformation (AVM) resection is one of the most challenging procedures in neuroanesthesia. Right now, cerebrovascular surgery is frequently done. The diagnosis of intracranial AVM is based on clinical symptoms and is supported by neuroradiological examination. For optimal perioperative management of patients with intracranial AVM abnormalities, anaesthetist should understand the pathophysiology of the AVM disorder and its management. Therapy in AVM patients is highly dependent on the size of the AVM diameter and its location. The main target of surgery is to cut the blood supply to the AVM. In AVM resection, as soon as AVM can be identified, the blood supply will be stop anf the nidus will be remove. In this case report: a 19 year old woman, score GCS 15, 59 kg in weight cames with frequent headache since the previous years before entered the hospital. Brain angiographic results showed intracranial AVM features in the right parietal lobe. The patient underwent the AVM resection action and the operation was done successfully. No neurological deficit was found. Postoperative patients were admitted to the ICU and moved to the ward the next day.

Tatalaksana Anestesi Perioperatif pada Pasien dengan Perdarahan Intraserebral Spontan akibat Hipertensi Emergensi: Serial Kasus Lira Panduwaty; Dewi Yulianti Bisri
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Perdarahan intraserebral (PIS) mempunyai angka morbiditas dan mortalitas yang tinggi. Hanya 20% individu yang bertahan dari penyakit ini dapat hidup dalam 6 bulan. Masih terdapat kontroversi dalam tatalaksana PIS, seperti meregulasi tekanan darah, mencegah perluasan hematoma, edema otak, dan mempertahankan perfusi serebral. Tujuan penelitian ini adalah untuk membahas prosedur tatalaksana perioperatif PIS dengan hipertensi emergensi. Subjek dan Metode: Penelitian serial kasus dari 3 kasus dengan gangguan kesadaran (skor GCS ≤14), didiagnosa PIS, akan dilakukan kraniotomi evakuasi hematoma. Dilakukan pengelolaan tekanan darah prabedah dengan target tekanan darah rata-rata (TAR) 125–130 mmHg. Induksi dengan fentanyl 3 ug/kg, propofol 2,5 mg/kg, vecuronium 0,1 mg/kg, lidokain 1,5 mg/kg dan rumatan anestesi dengan O2, air, isoflurane 1–1,5 vol%. Hasil: Pascabedah 2 kasus dirawat di ICU selama 2–3 hari dan satu kasus dirawat di neurocritical care unit (NCCU) selama 3 hari dan terdapat perbaikan GCS menjadi 15. Setelah itu dipindahkan ke ruangan dan mendapat perawatan selama 5–7 hari, dan dipulangkan setelah 7–15 hari. Simpulan: Masih ada kontroversi tentang terapi PIS yang optimal terutama dalam pengendalian tekanan darah. Tekanan darah yang tinggi dapat menimbulkan hematoma, tapi penurunan tekanan darah dapat menimbulkan penurunan perfusi otak. The Intensive Blood Pressure Reduction of Acute Cerebral Hemorrhage Trial (INTERACT) menemukan bahwa penurunan tekanan darah yang segera akan mengurangi resiko perluasan perdarahan tapi tidak mempunyai efek pada outcome, akan tetapi, pada ke 3 kasus tersebut menurunkan tekanan darah dalam waktu kurang dari 24 jam memberikan hasil yang baik. Perioperative Anesthesia Management in Patients with Spontaneous Intracerebral Haemorrhage (ICH) et causa Hypertensive Emergency: A Case Series Background and Objectives: Intracerebral hemorrhage (ICH) have a high rate of morbidity and mortality. Only 20% of individuals who survive ICH are independent at 6 months. Many issues need to be considered for the optimal management of ICH, such as blood pressure (BP) control, prevention of hematoma growth, containing brain edema, and preserving cerebral perfusion. The objective of this case series is to report perioperative management procedure for ICH with hypertensive emergency.Subject and Methods: A serial case study of three patients with decrease consciousness (score GCS ≤14), ICH, were planned for craniotomy evacuation. Perioperative management of BP has been done to a targetted mean arterial pressure (TAR) of 125–130 mmHg. Induction with fentanyl 3 ug/kg, propofol 2.5 mg/kg, vecuronium 0.1 mg/kg, lidocaine 1.5 mg/kg and maintain of anesthesia with O2, air, isoflurane 1–1.5 vol%. Results: Two patients were admitted to the ICU post-operatively for 2–3 days, one patient were admitted to the Neuro Critical Care Unit (NCCU) for three days, and had improvements of consciousness (GCS 15), then transferred to the ward for another 5–7 days, and finally discharged after 7–15 days. Conclusion: There are still controversies in the treatment of ICH, especially in the control of BP. High BP can lead to hematoma, but decrease in BP can reduce cerebral perfusion. The Intensive Blood Pressure Reduction of Acute Cerebral Hemorrhage Trial (INTERACT) found that early intensive BP management reduced the risk of hematoma expansion but had no effect on outcomes. However in all three cases above, a reduction in BP within 24 hours have provided good results.

Tatalaksana Anestesi pada Pasien Geriatri dengan Hematoma Subdural, Intraserebral, dan Subarahnoid yang Menjalani Kraniotomi Evakuasi Hematoma Monika Widiastuti; Iwan Abdul Rachman; Nazaruddin Umar
Jurnal Neuroanestesi Indonesia Vol 11, No 2 (2022)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera otak traumatik pada geriatri memiliki insiden 7–34% dengan penyebab utama adalah jatuh. Perdarahan subdural merupakan jenis cedera yang paling sering terjadi pada populasi geriatri. Hal ini sesuai dengan proses penuaan yang terjadi pada jaringan otak sehingga menyebabkan populasi ini sering mengalami perdarahan subdural jika mengalami cedera. Pasien perempuan berusia 72 tahun datang dengan keluhan nyeri kepala pasca terjatuh 6 hari sebelum masuk rumah sakit. Dari pemeriksaan fisik ditemukan kesadaran E3M5V6, tanpa adanya kelainan dan defisit neurologis dan hemodinamika stabil. Dari pemeriksaan penunjang Computed Tomography (CT) scan ditemukan subdural hematoma di regio frontotemporoparietalis dextra dan regio frontalis et temporalis sinistra yang menyebabkan midline shift ke arah sinistra, perdarahan subarahnoid di regio frontalis sinistra, perdarahan intraserebral di lobus temporalis sinistra. Operasi kraniotomi evakuasi hematoma dilakukan selama 3 jam dengan anestesi umum. Pertimbangan anestesi pada pasien ini adalah neuroanestesi dan anestesi geriatri dengan memperhatikan proses penuaan yang mempengaruhi perubahan fisiologi dan farmakologi pada pasien geriatri, riwayat komorbiditas dan polifarmasi. Tatalaksana perioperatif yang baik penting untuk mencegah cedera sekunder pada jaringan otak. Anesthetic Management of Geriatri Patient with Subdural, Intracerebral, and Subarachnoid Hemorrhage Underwent Craniotomy for Hematoma EvacuationAbstractWorldwide, the incidence of traumatic brain injury in geriatrics is 7–34%, with falls as the most common cause. Subdural hemorrhage is the most common injury that occur and is associated with the aging process of the brain, making geriatric patients prone developing subdural hemorrhage. A 72-years-old female came with a headache after fell to the ground 6 days before hospital admission. Physical examination revealed E3M5V6 without neurologic deficits and hemodynamically stable. A computed tomography scan resulted in subdural hematoma in right frontotemporoparietal region causing midline shifting to the left, subarachnoid hemorrhage in the left frontal region, intracerebral hemorrhage in the left temporal lobe. The patient underwent craniotomy evacuation of hematoma and lasted for 3 hours under general anesthesia. Anesthetic concerns are neuroanesthesia and geriatric patient considering the aging process affects physiologic and pharmacologic changes, comorbidities and polypharmacy. Comprehensive perioperative management is essential to prevent secondary brain injury and improve the outcome.

Penatalaksanaan Perioperatif pada Epidural Hemorrhage dengan Herniasi Serebral Silmi Adriman; Sri Rahardjo; Siti Chasnak Saleh
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Cedera kepala merupakan masalah kesehatan utama, pemicu kecacatan dan kematian di seluruh dunia. Epidural Hemorrhage (EDH) adalah salah satu bentuk cedera kepala yang sering terjadi. Epidural Hemorrhage umumnya terjadi karena robeknya arteri dan menyebabkan perdarahan di ruangan antara duramater dan tulang tengkorak. Munculnya tanda Cushing pada EDH akan memperburuk prognosis. Penatalaksanaan cedera kepala saat ini difokuskan pada stabilisasi pasien dan menghindari gangguan intrakranial ataupun sistemik sehingga dapat menghindari cedera sekunder yang lebih buruk. Seorang laki-laki, 18 tahun, dibawa ke rumah sakit dengan penurunan kesadaran pasca jatuh dari ketinggian kurang lebih 5 meter dengan posisi badan sebelah kanan jatuh terlebih dahulu. Setelah resusitasi dan stabilisasi didapatkan jalan napas bebas, laju pernapasan 12 x/menit (ireguler), tekanan darah 155/100 mmHg, laju nadi 58 x/menit (reguler). Pada pasien dilakukan tindakan kraniotomi evakuasi hematoma dengan anestesi umum dan dengan memperhatikan prinsip neuroanestesi selama tindakan bedah berlangsung. Perioperative Management of Epidural Hemorrhage withCerebral HerniationHead trauma is a major health problem and considered as the leading cause of disability and death worldwide. Epidural Hemorrhage (EDH) is commonly seen in head trauma. Epidural Hemorrhage usually occurs due to ripped artery that coursing the skull causing blood collection between the skull and dura. Cushing sign revealed in EDH may worsen the outcome. Head trauma management is currently focusing on patient’s stability and prevention the intracranial and haemodynamic instability to prevent the secondary brain injury. A 18 years old male patient, admitted to the hospital with decreased level of consciousness after felt down from 5 meters height with his right side of body hit the ground first. On examination, no airway obstruction found, respiratory rate was 12 times/min (irregular), blood pressure 155/100 mmHg, heart rate 58 bpm (regular). Patient was managed with emergency hematoma evacuation under general anesthesia and with continues and comprehensive care using neuroanesthesia principles.

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Home Page

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Contact Name Agni Susanti

Contact Email jurnalneuroanestesi@gmail.com

Phone +6287722631615

Journal Mail Official jni@inasnacc.org

Editorial Address Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

Location , INDONESIA

Abstract

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Contact Name
Agni Susanti

Contact Email
jurnalneuroanestesi@gmail.com

Phone
+6287722631615

Journal Mail Official
jni@inasnacc.org

Editorial Address
Jl. Prof. Eijkman No. 38 Bandung 40161, Indonesia Lt 4 Ruang JNI

Location
,

INDONESIA