Hamzah, Hanzah
Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Tatalaksana Kraniektomi Dekompresif pada Pasien Cedera Otak Traumatik Berat yang Disertai Peningkatan Tekanan Tinggi Intrakranial Menetap

Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

Tekanan tinggi intrakranial menetap adalah penyebab kematian terbesar pada pasien dengan cedera kepala traumatik berat. Pada cedera kepala berat, tatalaksana secara konservatif dan operatif dilakukan untuk meminimalisir terjadinya cedera otak sekunder. Peningkatan tekanan intrakranial biasanya disebabkan karena edema otak, hal ini sangat penting dan menentukan hasil luaran pasien/Glasgow outcomes scale (GOS) atau Extended GOS (GOSE). Data klinis menunjukkan bahwa kraniektomi dekompresif menurunkan angka kematian, meningkatkan fungsi pemulihan, menurunkan durasi perawatan di ICU dan meningkatkan hasil luaran berdasarkan Barthel Index Score. Kraniektomi dekompresif sering dilakukan sebagai penyelamatan empiris untuk melindungi kerusakan otak lebih lanjut akibat efek edema dan hipertensi intrakranial menetap. Konsep utama tatalaksana pasien dengan tekanan tinggi intrakanial yang menetap adalah menjaga aliran darah otak dan tekanan perfusi otak.Decompressive Craniectomy Management in Patients with Severe Traumatic Brain Injuries Accompanied by Refractory Intracranial HypertensionRefractory intracranial hypertension is the biggest cause of death in patients with severe traumatic head injury. In severe head injuries, conservative management and surgery are performed to minimize the occurrence of secondary brain injury. The increase in intracranial pressure is usually caused by brain edema, this is very important and determines the outcomes of the Glasgow outcomes scale (GOS) or extended GOS (GOSE). Clinical data show that decompressive craniectomy reduces mortality, improves recovery function, decreases duration of ICU treatment and increases outcome outcomes based on the Barthel Index Score. Decompressive craniectomy is often performed as an empirical salvage to protect further brain damage due to the effects of edema and refractory intracranial hypertension. The main concept of managing patients with refractory intracranial hypertension is to maintain cerebral blood flow and cerebral perfusion pressure.