Umar, Nazaruddin
JIK ( Jurnal Ilmu Kedokteran )

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Anestesi Untuk Drainase Abses Otak pada Pasien dengan Tetralogy Fallot yang tidak Dikoreksi Prasetya, Raka Jati; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Kejadian abses otak sangat jarang terjadi tapi sangat berpotensi untuk mengancam jiwa. Yang termasuk faktor predisposisi untuk abses otak termasuk jantung bawaan sianotik, dengan faktor predisposisi sekitar 5 sampai 18,7% pasien dengan PJK didapati abses otak. Abses otak dapat terjadi dikedua hemisfer, dan sekitar 64-76% abses berada di daerah perietal, lobus frontal atau temporal. Kebanyakan abses otak terjadi pada satu lobus, namun 10-27% melibatkan melibatkan lebih dari satu lobus. Sebagian besar penyakit jantung bawaan yang menyebabkan komplikasi di dalam otak termasuk di dalam golongan penyakit jantung bawaan sianotik yang terbanyak adalah Tetralogi of Fallot (TOF) dan transposisi arteri besar. Pada penyakit jantung bawaan sianotik serimg di temukan Sterptococcus, sedangkan bila abses terjadinya pasca kraniotomi sering ditemukan Staphylococcus atau Streptococcus. Dasar pengobatan abses otak adalah mengurangi efek masa dan menghilangkan kuman penyebab. Penatalaksanaan abses otak dapat dibagi menjadi terapi bedah dan terapi konservatif. Untuk menghilangkan penyebab, dilakukan operasi baik aspirasi maupun eksisi dan pemberian antibiotik. Penatalaksanaan anestesi pada pasien ini merupakan gabungan pemahaman tentang patofisiologik TOF dan tehnik neuroanestesi. Tujuan dari manajemen anestesi pada pasien dengan TOF adalah dengan mempertahankan volume intravaskular dan sytemic vascular resistance (SVR). Peningkatan pulmonary vascular resistance (PVR), seperti yang mungkin terjadi akibat asidosis atau tekana di saluran napas yang berlebihan, harus dihindari. Kematian adalah obat induksi yang sering digunakan karena efeknya pada SVR.Anesthesia for Brain Abscess Drainage in Patient with UncorrectedTetralogy of FallotIncidence of barin abscess is a rare but potentilly highly threatening . That included predisposing factors for brain abscess including cyanotic congenital heart disease, with a predisposing factor of about 5 to 18.7% of patients with CHD found a brain abscess. A brain abscess can occur in both hemispheres, And about 64-76% abscess in the parietal, frontal or temporal lobes. Most brain abscesses occur in the lobe, but 10-27% involving  involving more than one lob. Most congenital heart disease cause complications in the brain, including within the category of cyanotic congenital heart disease, the vast majority were tetralogy of fallot (TOF) and transposition of the great arteries. In cyanotic congenital heart disease often found streptococcus, whereas when the post-craniotomy abscesses are often found Staphylococcus or Streptococcus. Primary brain abscess treatment is to reduce the mass effect and eliminate germs. Management of brain abscess therapy can be divided into surgical and conservative teratment. To eliminate the cause, either aspiration or surgical excision and antibiotics. Management of anesthesia in these patients is a combination of undrstanding neuroanesthesia techniques and pathophysiologic TOF. The purpose of the management of anasthesia in patients wuth TOF is to maintain intravascular volume and systemic vascular resistance (SVR). The increase in pulmonary vascular resistance (PVR), as might occur due to acidosis or airway pressure overload, should be avoided. Ketamine is the common drug for induction, because its effect on SVR.
Trombosis Vena Otak Marwan, Kenanga; Jasa, Zafrullah Kany; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 7, No 2 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Trombosis vena otak (TVO) adalah trombosis pada vena otak dan sinus mayor duramater. Faktor resiko terjadinya TVO meliputi faktor genetik trombofilia dan penggunaan kontrasepsi hormonal. Manifestasi klinis TVO sangat bervariasi. Timbulnya gejala dan tanda bersifat akut, subakut, atau  kronis. Empat sindrom  utama yang muncul: hipertensi intrakranial terisolasi, kelainan neurologis fokal, kejang, dan ensefalopati. Sindrom ini dapat muncul dalam kombinasi atau terisolasi tergantung pada luas dan lokasi TVO. Tatalaksana fase akut dari TVO berfokus pada antikoagulan, manajemen dari sekuele seperti kejang, peningkatan tekanan intrakranial, dan infark vena.2 Penyebab utama kematian pasien TVO selama fase akut adalah herniasi transtentorial yang kebanyakan disebabkan karena perdarahan vena. Mayoritas pasien mengalami penyembuhan parsial dan sekitar 10% mengalami defisit neurologis permanen hingga 12 pasien terjadi pada bulan ketiga) dan akan terbatas setelahnya. Rekurensi dari TVO termasuk jarang (2,8%).Cerebral Venous ThrombosisCerebral venous thrombosis is a condition of thrombosis in cerebral veins and major sinus duramater. Risk factor of cerebral venous thrombosis include genetic factor like thrombophylia and hormonal contraception. There are variations in clinical manifestation of cerebral venous thrombosis. The sign and symptom could be divided into acute, subacute or chronic onset. There are 4 syndroms of clinical manifestations of cerebral venous thrombosis: isolated intracranial hypertension, focal neurologic deficits, seizure, and encephalopathy. The focus of treatment in cerebral venous thrombosis is anticoagulant therapy, sequele of seizure, to treat intracranial hypertension and venous infract. The main cause of death patient with acute onset cerebral venous thrombosis is transtentorial herniation due to venous bleeding. Partial recovery happens in mostly patient with cerebral venous thrombosis anda about 10% had permanent neurologic deficits untill 12 moths. Recanalisation occurs in the first month after cerebral venous thrmbosis (84% patient in the third month) and limited after that. Cerebral venous thrombosis recurrency is rare (2,8%).
Perbandingan Tingkat Sedasi Klonidin Syrup 2 mcg/kgBB dengan Diazepam Syrup 0.4 mg/kgBB sebagai Premedikasi pada Pasien Anak yang Menjalani Pembedahan dengan General Anestesi Muharrami, Vera; Nasution, A. Sani P.; Umar, Nazaruddin
JIK ( Jurnal Ilmu Kedokteran ) Vol 5, No 2 (2011)
Publisher : JIK ( Jurnal Ilmu Kedokteran )

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Introduction: Anxiety in children undergoing surgery is characterized by subjective feeling of tension, apprehension,nervousness and worry that may be expressed in various forms. Clonidine, an alpha 2-adrenoceptor agonist, has beenshown to be as a preanesthetic medication in childrens. The current study was designed to investigate the differencesof level sedation clonidine syrup and diazepam syrup as a premedicant in children.Methods: In a randomized, double-blind, controlled clinical trial, 40 children, aged 2-12 yr, undergoing electivesurgery received 2 micrograms/kg clonidine syrup or 0.4 mg/kg diazepam syrup orally. These agents were administered120 min before the estimated time of induction of general anesthesia and noted the children’s level of sedation. Thelevel of sedation were compared among the two groups. PASS <1 demanded rescue intravenous sedation.Result: Clonidine syrup 2 mcg/kgBB provided better quality of sedation after 60 min of premedicant but it wasn’tsignificant(1.8±0.92) and diazepam syrup (0.80±0.89; p>0.05) and number of patients with rescue intravenous diazepamacceptance were same both clonidine group compared to diazepam, there was no significant difference between twogroups, 10% of clonidine group patients, 10 % of diazepam group patients (p>0.05). No clinically significanthypotension or bradycardia was observed after preanesthetic medications of diazepam and clonidine syrup.Discussion: These data indicate that, even in pediatric surgery, the 2 micrograms/kg syrup clonidine is an effectivepremedication. However, the safety and optimal dose of clonidine in this setting remain to be determined.
Penatalaksanaan Anestesi dengan TIVA Propofol-Dexmedetomidine-Fentanyl untuk Operasi Meningioma Frontalis Sinistra Mangastuti, Rebecca Sidhapramudita; Wargahadibrata, A. Himendra; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 3, No 3 (2014)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Meningioma merupakan tumor intrakranial jinak yang sering ditemukan. Berasal dari jaringan meningen dan medulla spinalis, tidak tumbuh dari jaringan otak. Pada kasus ini, pasien laki-laki, 46 tahun, 80 kg, datang ke rumah sakit dengan keluhan kejang berulang dan sakit kepala yang hilang timbul sejak 5 bulan yang lalu. Kesadaran composmentis, GCS 15, pupil isokor bilateral 2 mm, hemodinamik stabil, jantung dan paru tidak ada kelainan dan tidak ada kelumpuhan atau kelemahan pada ke empat ekstremitas. Magnetic Resonance Imaging (MRI) brain ditemukan masa hipointens yang melekat dengan meningen di frontal kiri ukuran 52x48x43 mm, kesan convexitas meningioma disertai perifokal edema dengan midline shift ke kanan sekitar 7 mm. Disimpulkan meningioma frontal sinistra dan dianjurkan kraniotomi pengangkatan tumor. Operasi dilakukan dengan anestesi umum. Tehnik anestesi menggunakan Total Intra Venous Anesthesia (TIVA) dengan syringe pump. Operasi berlangsung selama 7 jam dan tumor dapat terangkat semua. Jumlah perdarahan 1000 mL. Pasien mendapat 300 ml Fresh Frozen Plasma (FFP) dan 500 ml Packed Red Cell (PRC) intraoperasi. Untuk mengurangi tekanan intrakranial, diberikan manitol 0,5 gram/kgBB dan drainase cairan serebrospinal 10–20 mL langsung ke ventrikel lateral oleh operator. Pascaoperasi, pasien diekstubasi dan rawat diruang ICU. Dengan data five year survival rate untuk meningioma jinak 70%, meningioma ganas 55%, diharapkan prognosis pasien pascaoperasi adalah dubia ad bonam. Management Anesthesia with TIVA Propofol-Dexmedetomidine-Fentanyl for Meningioma Frontalis Sinistra OperationMeningiomas are the most common benign intracranial tumors. These tumors originate from the meninges and spinal cord, not from the brain tissue. A 46 year old 80 kgs male patient, was admited to the hospital with recurrent seizures and intermittent headaches that occured since five months ago. He was fully alert, GCS 15, both pupils were isokor (2 mm), with stable hemodynamic, no parese in all extremities and normal heart and lung. Magnectic Resonance Imaging (MRI) result showed a 52x48x43 mm mass attached to the meninges at the left frontal with perifocal tumour edema and midline shifted to the right about 7 mm. The patients was diagnosed with the left frontal meningioma and suggested for craniotomy tumour removal. The surgery was performed under general anesthesia using. Total Intra Venous Anesthesia (TIVA) with syringe pump. The 7 hours surgery performed uneventfully with total bleeding of 1000 mL and the patient was received 300 mL Fresh Frozen Plasma (FFP) and 500 ml Packed Red Cell (PRC) intraoperatively. To reduce intracranial pressure, a 0.5gr/kg mannitol was and a 10–20 cc of cerebrospinal liquor drainage through the lateral ventricle was performed by the operator. The patient was extubated after the operation and admitted the ICU for futher management. With the five year survival rate of 70% for benign meningioma and 55% for malignant meningiomas, the prognosis of this patient is dubia ad bonam.
Subdural Empiema L1-5 Pasca Anestesi Anestesi Neuraksal A. Chalil, M. Jalaludin; Umar, Nazaruddin
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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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.
Penanganan Perioperatif Pasien Pediatrik dengan Cedera Kepala Berat Halimi, Radian Ahmad; Umar, Nazaruddin; Saleh, Siti Chasnak; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Cedera otak traumatika (COT) merupakan penyebab kematian dan kecacatan terbesar di Amerika dan negara industri lainnya di dunia. Anak dari usia balita hingga remaja yang mengalami cedera otak berat biasanya akan dapat menghadapi kecacatan yang signifikan selama beberapa dekade. Seorang anak laki-laki berumur 3 tahun dengan diagnosa cedera kepala berat akibat perdarahan subdural di temporo occipital kiri dan fraktur terdepresi yang disebabkan karena jatuh dari ketinggian tiga meter, direncanakan dilakukan kraniektomi dekompresi karena terjadi penurunan kesadaran signifikan. Berbagai komplikasi dan permasalahan terjadi yakni perdarahan masif intraoperatif, edema otak kongestif disertai demam pascaoperasi di ruang perawatan intensif, hingga akhirnya pasien dapat pindah ke ruang perawatan biasa dan dilakukan rawat jalan. Penanganan COT berat memerlukan kemampuan seorang ahli anestesi dalam melakukan resusitasi otak dengan ABCDE neuroanestesi, kontrol terhadap hipertensi intrakranial, neuroproteksi dan neurorestorasi.Perioperative Treatment Pediatric Patients with Head InjuriesTraumatic brain injury (TBI) is the largest cause of death and disability in the United States and other industrialized countries in the world. Young age patient who suffered severe TBI typically face significant disability for decades. A 3 years old boy with diagnosis of severe TBI as a result of subdural hemorrhage in the left temporo occipital and fracture depressed due to fall from a height of three meters, was planed to perform decompresive craniectomy because decreased conciouseness significantly.Various complications and problems occur, intraoperative masive bleeding, postoperative diffuse brain edema with persistent hyperthermia on the intensive care unit, until the patient can be moved to a regular ward and can be done outpatient. The management of severe head injury requires the ability of an anesthesiologist in performing brain resuscitation with ABCDE neuroanesthesia, control of intracranial hypertension and neurorestoration.
Perdarahan Epidural Spontan Akut pada Kombinasi Terapi Rivaroxaban, Clopidogrel dan Lumbrokinase Irina, Sinta; Umar, Nazaruddin; Arifin, Hasanul; Rehatta, Nancy Margareta; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 5, No 2 (2016)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Perdarahan intrakranial spontan pada terapi antikoagulan rivaroxaban mulai sering ditemukan, apalagi bila dikombinasi dengan antiplatelet clopidogrel maupun fibrinolitik lumbrokinase merupakan hal yang sering ditemukan pada penderita trombosis. Perdarahan intrakranial spontan terbanyak adalah perdarahan intracerebral. Perdarahan spontan epidural (EDH) akut merupakan hal yang jarang ditemukan, biasanya terjadi karena ada penyakit yang mendasarinya. Penatalaksanaan pada kasus ini berdasarkan patofisiologinya dan melibatkan multidisiplin ilmu lainnya. Seorang laki-laki, 26 tahun berat badan 80 kg yang didiagnosa deep vein thrombosis (DVT) mengalami penurunan kesadaran mendadak, pupil anisokor 4 mm/1mm ketika sedang beraktivitas. Tidak dijumpai riwayat cedera kepala. Setelah diresusitasi didapatkan hasil head CT-scan dengan EDH temporoparietal dextra 50 cc, dilakukan dekompresi craniektomi dan evakuasi EDH. Setelah 10 jam pasca operasi terjadi gejolak hemodinamik dan dilakukan head CT-scan ulang dan didapatkan EDH 80 cc dan minimal perdarahan intracerebral. Dilakukan redo craniektomi. Pasca operasi dirawat di ICU dengan koreksi faktor koagulasi. Pasien kembali komposmentis GCS 15 dengan gejala sisa hemiparese sinistra sementara.Acute Spontaneus Epidural Hemorrhage due to Combination Therapy Rivaroxaban, Clopidogrel and LumbrokinaseSpontaneous intracranial hemorrhage on anticoagulant therapy rivaroxaban lately often found, especially when combined with clopidogrel antiplatelet or fibrinolytic lumbrokinase is often found in patients with thrombosis. Spontaneous intracranial hemorrhage is most widely occured is intracerebral hemmorrhage. Spontaneous epidural hemorrhage (EDH) acute is a uncommon, usually occur because there is an underlying disease. Treatment on the case based on patophysiology and involves a multidisciplinary peer other sciences. A young man, 26 years old weight 80 kg which was diagnosed with deep vein thrombosis (DVT) awareness of sudden decline, the pupil anisokor 4 mm/1mm while activity. No head trauma history. After resuscitation, head Ct-scan with EDH temporoparietal dextra 50 cc, carried out the evacuation EDH and decompression craniektomi. After 10 hours of post-operative haemodynamic turmoil happened and done a head ct-scan and obtained EDH 80 cc and minimal intracerebral hemorrhage. Do redo craniektomi. Post-operative hospitalized in ICU with correction factor for coagulation. The patient recovers conciousness into composmentis GCS 15 with sequelae hemiparese sinistra temporary.
Implikasi Anestesi Pasien Cedera Kepala Traumatik dengan Penyakit Jantung Bawaan (PJB) Sianotik: Masalah Hiperviskositas Darah Suyasa, Agus Baratha; Umar, Nazaruddin; Oetoro, Bambang J.
Jurnal Neuroanestesi Indonesia Vol 2, No 3 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Saat ini banyak penderita penyakit jantung bawaan (PJB) yang mampu bertahan sampai dewasa (15–25%). Penderita PJB memiliki anatomi serta fisiologi yang kompleks dan spesifik dengan morbiditas dan mortalitas perioperatif yang tinggi. Anak-anak dengan PJB meningkatkan resiko henti jantung serta mortalitas 30 hari setelah pembedahan mayor maupun minor dibandingkan dengan anak-anak yang sehat. Cedera otak traumatik merupakan salah satu kondisi yang mengancam jiwa dan merupakan penyebab utama kecacatan serta kematian pada dewasa dan anak-anak. Edema serebral sering ditemui dalam praktek klinis serta dapat menimbulkan masalah besar termasuk iskemia serebral, yang memperburuk aliran darah otak regional dan global, pergeseran kompartemen intrakranial akibat peningkatan tekanan intrakranial (TIK) sehingga menekan struktur vital otak. PJB sianotik memiliki kadar hematokrit yang meningkat dan diasumsikan berhubungan dengan resiko trombosis serebral dan stroke. Peningkatan massa sel darah merah dicurigai sebagai penyebab sindroma hiperviskositas dimana kadar hematokrit selanjutnya menjadi faktor resiko tejadinya infark serebral. Terdapat hubungan yang signifikan antara aliran darah otak dan kadar hematokrit namun belum jelas dinyatakan dalam literatur berapa batas kadar hematokrit, dan kriteria untuk dilakukan phlebotomi. Namun beberapa argumentasi menyatakan polisitemia (kadar hematokrit >60%) memiliki efek yang merugikan dan harus diturunkan dengan phlebotomi karena kompensasi yang berlebihan akan mengganggu aliran darah regional serta aliran darah serebral Anesthesia Implication in a Traumatic Brain Injury Patient with Cyanotic Congenital Heart Disease (CHD): Blood hyperviscosity problem Many patients with congenital heart disease (CHD) survive to adulthood period (15–25%). Patients with CHD have a complex and specific anatomy and physiology with high perioperative morbidity and mortality. Children with congenital heart disease have an increased risk of cardiac arrest and 30 days mortality after both major and minor surgeries compared to healthy children. Traumatic brain injury is one of a life-threatening conditions which is the leading cause of disability and death in both adults and children. Cerebral edema is commonly encountered in clinical practice which have potential to cause major problems including cerebral ischemia, which was worsen the regional and global cerebral blood flow, intracranial compartment shift due to an increase in intracranial pressure (ICP) therefore pressing the vital structures of the brain. Cyanotic congenital heart disease patients have an increased hematocrit levels and this is assumed to be related to the risk of cerebral thrombosis and stroke. Increased red blood cell mass is suspected as the cause of hyperviscosity syndrome in which the hematocrit levels is a further risk factor for cerebral infarction is a significant relationship between cerebral blood flow and hematocrit levels. However the haematocrit unit and criterias for phlebotomy has not been explicitly stated in the literature. Some arguments stated that polycythemia (hematocrit levels >60%) had an adverse effect and should be reduced by phlebotomi as excessive compensation would disrupt the regional blood flow and cerebral blood flow. 
Total Intravenous Anesthesia pada Geriatri dengan Meningioma Parietalis Mangastuti, Rebecca Sidhapramudita; Umar, Nazaruddin; Marsudi, Marsudi
Jurnal Neuroanestesi Indonesia Vol 4, No 2 (2015)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Meningioma merupakan tumor intrakranial jinak yang sering ditemukan. Tumor ini berasal dari jaringan meningen dan medulla spinalis, tidak tumbuh dari jaringan otak. Gejala klinis baru dirasakan saat terjadi penekanan pada otak atau jaringan yang terdesak oleh tumor. Operasi pengangkatan tumor meningioma merupakan tindakan yang dianjurkan. Penatalaksanaan anestesi bertujuan menghindari terjadinya hipertensi intrakranial dan pembengkakan otak (brain bulging). Pada kasus ini, pasien wanita, usia 71 tahun, berat badan 60 kg, datang ke rumah sakit dengan keluhan tangan dan kaki kanan lemah dan tidak dapat berbicara (aphasia) sejak 2 bulan sebelum masuk rumah sakit. Kesadaran somnolen, E3M6V afasia, pupil isokor bilateral 2 mm, hemodinamik stabil, jantung normal, tuberculosis paru sinistra. Fungsi motorik dan sensorik ekstremitas kanan terganggu. MRI 3T dan MRA 3T Head Contrast didapatkan massa tumor kistik ring enhance 5,8 x 4,6 x 5 cm berisi cairan kental.Tampak pula massa tumor padat dan bercak perdarahan didalamnya ukuran 4,3 x 5,1 x 5 cm mencakup lobus parietal kiri dan lobus occipital kiri disertai perifokal edema disekitarnya. Dari hasil yang ada, disimpulkan pasien menderita meningioma parietalis sinistra dan tindakan yang dianjurkan adalah craniotomi pengangkatan tumor. Operasi dilakukan dengan anestesi umum. Operasi berlangsung selama 6,5 jam  dan tumor dapat terangkat semua. Jumlah perdarahan 2000 ml. Pasien mendapat 300 ml Fresh Frozen Plasma (FFP) dan 500 ml Packed Red Cell (PRC) intraoperasi. Untuk mengurangi tekanan intrakranial, digunakan total intra venous anesthesia (TIVA) dengan syringe pump dan diberikan manitol 0,5 gram/kgBB.  Pascaoperasi, pasien tidak diekstubasi dan rawat diruang ICU. Five year survival rate untuk menigioma jinak 70%, meningioma ganas 55%. Total Intravenous Anesthesia for Elderly with Meningioma Parietalis SinistraIntracranial meningiomas are benign tumors that are often found. These tumors originate from the meninges and spinal cord tissue, brain tissue does not grow out of. Clinical symptoms felt during a new emphasis on the brain or tumor tissue driven by. Surgical removal of the meningiomas tumor is a recommended actions. Management of anesthesia aims to avoid the occurrence of intracranial hyperternsion and brain bulging. In this case, female, 71 years, weight 60 kg, came to the hospital with complaints of arm and right leg is weak and unable to speak (aphasia) since 2 months before admission. Somnolence, E3M6V aphasia, pupil isocor 2 mm, hemodynamic stable, normal heart, the left pulmonary had tuberculosis. Motor function and sensory impaired right limb. MRI 3T and MRA head contrast found cystic tumor mass 5,8 x 4,6 x 5 cm and solid tumor mass measures 4,3 x 5,1 x 5 cm. From the result, it was consluded the patients suffering from the left parietal meningioma and recommended actions are craniotomy removal of the tumor. The operation if perfomed under general anesthesia. The operation lasted for 7 hours and the tumor can be taken out. The amount of bleeding 2000 ml. Patients received 300 ml Fresh Frozen Plasma (FFP) and 500 ml Packed Red Cell (PRC). To reduce intracranial pressure, we used total intra venous anesthesia (TIVA) and given manitol 0,5 gr/kg. Postoperatively, patients had not been extubation and take care in ICU unit. Five year survival rate of 70% for benign meningioma and 55% for malignant meningiomas.  
Tatalaksana Anestesi pada Direct Clipping Aneurisma Otak Laksono, Buyung Hartiyo; Umar, Nazaruddin; Rasman, Marsudi
Jurnal Neuroanestesi Indonesia Vol 4, No 3 (2015)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

Perdarahan subarachnoid (SAH) yang diakibatkan oleh pecahnya aneurisma otak menyumbang sekitar 85% dari kejadian SAH non traumatik. Insidensi sekitar 8–10 per 100.000 penduduk per tahun atau sekitar (0,008%). Rangkaian tatalaksana kasus SAH mempengaruhi outcome dari hasil terapi, mulai dari pertolongan pertama pada prehospital, transportasi, diagnosis awal, manajemen kegawatdaruratan dini, tindakan neuroradiologi intervensi ataupun pembedahan dan perawatan intensif pasca tindakan definitif. Pada laporan kasus ini, pasien wanita usia 65 tahun, berat badan 50 kg dengan diagnosa SAH hari ke 18 karena pecahnya aneurisma arteri serebri media disertai defisit neurologis ringan. Pembedahan dilakukan tindakan kraniotomi direct clipping aneurisma. Prinsip anestesi yang dilakukan adalah pemeliharaan homeostasis dan Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP) yang efektif, tindakan pencegahan peningkatan tekanan intrakranial (Intracranial Pressure-ICP), pembengkakan otak dan manajemen vasospasme serebral. Operasi berjalan 6 jam dan dilakukan rapid emergence. Outcome pembedahan sesuai yang diharapkan. Anestesi mempunyai peranan yang sangat penting dalam manajemen secara keseluruhan pada pasien ini untuk memberikan manajemen proteksi otak yang maksimal selama pembedahan sehingga memperoleh hasil akhir pembedahan yang sukses. Anesthetic Management in Direct Clipping Cerebral AneurysmaSubarachnoid hemorrhage (SAH) caused by rupture of a brain aneurysm accounts for about 85% of the incidence of non-traumatic SAH. The incidence is approximately 8-10 per 100,000 populations per year, or about (0.008%). The management of SAH affects the outcome, ranging from first aid in Prehospital, transportation, early diagnosis, early emergency management, neuroradiology action or surgical interventions and intensive therapy after definitive care. In this case report, a 65 years old female, 50 kgs, diagnosised with SAH day 18 due to middle cerebral artery aneurysm rupture with mild neurological deficits. Craniotomy was performed using direct aneurysm clipping. The anesthesia principle is to maintain adequate homeostasis and effective Cerebral Perfusion Pressure (CPP)/Transmural Pressure (TMP), preventing increase in ICP, brain swelling and management of cerebral vasospasm. The operation was done in 6 hours with rapid emergence. The outcome of surgery was as expected. Anesthesia has a very important role in the overall management of these patients to provide optimal brain protection management during surgery in obtaining successful outcome.