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Jurnal Neuroanestesi Indonesia
ISSN : 20889670     EISSN : 24602302     DOI : -
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 Indonesia Society of Neuroanesthesia & Critical Care (INA-SNACC) (abbrev: JNI).
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Articles 194 Documents
Anestesia pada Tindakan Dekompresi Foramen Magnum pada Pasien dengan Malformasi Arnold Chiari Umar, Nazaruddin; Prabowo, Haryo; Hamdi, Tasrif
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v2i2.163

Abstract

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 AbstractThe 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.
Penurunan Kadar Glutamat pada Cedera Otak Traumatik Pascapemberian Agonis Adrenoseptor Alpha-2 Dexmedetomidin sebagai Indikator Proteksi Otak Prihatno, MM Rudi; Harahap, M. Sofyan; Akbar, Ieva B; Bisri, Tatang
Jurnal Neuroanestesi Indonesia Vol 3, No 2 (2014)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

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.
Penanganan Anestesi pada Operasi Olfactory Groove Meningioma Adriman, Silmi; Bisri, Dewi Yulianti; Rahardjo, Sri; Wargahadibrata, A Himendra
Jurnal Neuroanestesi Indonesia Vol 4, No 1 (2015)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

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
Pengelolaan Anestesi untuk Evakuasi Hematoma Epidural pada Wanita dengan Kehamilan 22–24 Minggu Sumardi, Fitri Sepviyanti; Umar, Nazaruddin; 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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Abstract

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.
Konsep Dasar Target Controlled Infusion (TCI) Propofol dan Penggunaannya pada Neuroanestesi Krisna J. Sutawan, Ida Bagus; Suarjaya, I Putu Pramana; Saleh, Siti Chasnak; Wargahadibrata, A. Hmendra
Jurnal Neuroanestesi Indonesia Vol 6, No 1 (2017)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v6i1.40

Abstract

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 Rachman, Iwan Abdul; Fuadi, Iwan; Surahman, Eri
Jurnal Neuroanestesi Indonesia Vol 2, No 2 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Abstract

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.
Tatalaksana Anestesi Pada Posisi Telungkup untuk Laminektomi Pengangkatan Tumor Satriyanto, M. Dwi; Harahap, M. Sofyan; Oetoro, Bambang J.; Wargahadibrata, A. Hmendra; Saleh, Siti Chasnak
Jurnal Neuroanestesi Indonesia Vol 1, No 2 (2012)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Tindakan anestesi dengan posisi telungkup sering diperlukan guna memfasilitasi akses operasi pada berbagai tindakan bedah termasuk bedah saraf, antara lain pada tindakan pembedahan tulang belakang. Selain perubahan fisiologis, dapat juga terjadi beberapa komplikasi pada posisi telungkup yang harus mendapat perhatian khusus, sehingga diperlukan pemahaman yang baik akan masalah ini. Kasus: Telah dilakukan laminektomi guna pengangkatan tumor intra-ekstradura setinggi vertebra lumbal 4 sampai sakrum 2 dalam posisi telungkup pada seorang pasien laki-laki berusia 18 tahun. Pengaturan posisi dari telentang ke telungkup prabedah maupun pengembalian posisi dari telungkup ke telentang pascabedah, mendapat perhatian khusus. Status hemodinamik selama tindakan anestesi berlangsung dengan baik. Pascabedah, pasien di observasi di ruang pulih selama beberapa jam, kemudian dipindahkan ke ruang rawat setelah skor modifikasi dari Aldrete mencapai 10.Anesthesia Management In Prone Position For Laminectomy Tumor RemovalAnesthesia procedure in the prone position was often necessary in order to facilitate access to a variety of surgical operations, including neurosurgery among others, the spine surgery. In addition to physiological changes, some complications can also occur in the prone position that should receive special attention, so it requires a good understanding of this issue.  Case: Laminectomy was being done for removal of the tumor intra-ekstradura at 4th lumbar vertebra to 2nd sacrum vertebra in the prone position in a male patient aged 18 years. Arrangement of the supine position to prone position preoperative and return to the supine position of the postoperative, gets special attention. emodynamic status during anesthesia procedure was progressing well. Postoperative, patients in the observation in the recovery room for several hours, then transferred to the ward after modified Aldrete score reached 10.
Penatalaksanaan Anestesi pada Pembedahan Akustik Neuroma dengan Monitoring Saraf Kranialis Christanto, Sandhi; Suarjaya, I Putu Pramana; Rahardjo, Sri
Jurnal Neuroanestesi Indonesia Vol 5, No 1 (2016)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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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.
Patofisiologi Kejang dan Perubahan Susunan Saraf Pusat pada Eklampsia Taslim, Emilzon
Jurnal Neuroanestesi Indonesia Vol 2, No 1 (2013)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

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Eklampsia merupakan komplikasi serius kehamilan yang menimbulkan berbagai komplikasi neurologis seperti nyeri kepala, gangguan penglihatan, mual, muntah, koma, dan kejang. Patofisiologi/ Patogenesis kejang serta perubahan sitim saraf pusat eclampsia belum diketahui secara pasti dan merupakan pokok bahasan yang terus diteliti secara ekstensif. Beberapa mekanisme etiologi yang berimplikasi terhadap patofisiologi /pathogenesis kejangeklampsiadan berbagai perubahan sistem saraf pusat meliputi vasospasme hipertensis ensefalopati, edema serebral (terutama edema vasogenik), iskemia uteroplasental, dan kerusakan/ disfungsi endotel. Komplikasi neurologic eklampsia mirip dengan hipertensi ensefalopati yang ditandai dengan peningkatan tekanan darah secara akut dan ekstrim sehingga menyebakan kerusakan sawar darah otak, berkuranganya aliran darah ke otak, gangguan autoregulasi, hiperperfusi, dan edema. Edema otak pada pasien peeklampsia-eklampsia juga berhubungan dengan abnormalitas penanda kerusakan endotel. Pathophysiology of Convulsion and Central Nervous System Changes in EclampsiaEclampsia is a serious complication of pregnancy due to some neurologic complications, including convulsion and central nervous system changes in eclampsia remains unknown and contionues to be the subject of extensive investigation. Some of etiologic mechanisms that are implicated in the pathophysiology/pathogenesis of eclamptic convulsion and other central nervous system change have included vasopasm hypertensive, encephalopathy, cerebral edema (mostly vaspgenic edema), the uteroplacental ischemia, and endothelial damage/endothel dysfunction. Neurologic complication of eclampsia are thought to be similar to hypertensive encephalopathy in which an acute, excessive elevation in blood pressure causes blood-brain barrier disruption, lossof cerebral blood flow autoregulation, hyperperfusion, and edema formation, Brain edema in patients with preeclampsia-eclampsia also was associated with abnormalities in endhotelial damage markers.
Pengelolaan Anestesi untuk Eksisi Tumor Intradura Intramedula (IDIM) Setinggi Vertebra Cervical 5-6 dengan Panduan Intraoperative Neurophysiological Monitoring Santosa, Dhania Anindita; Harijono, Bambang; Hamzah, Hamzah; Jasa, Zafrullah Kany; Rehatta, Nancy Margareta
Jurnal Neuroanestesi Indonesia Vol 7, No 3 (2018)
Publisher : Departement of Anesthesiology and Intensive Care Dr. Hasan Sadikin Hospital Bandung

Show Abstract | Original Source | Check in Google Scholar | DOI: 10.24244/jni.v7i3.26

Abstract

Eksisi tumor intradura intramedula (IDIM) dengan bantuan intraoperative neurophysiological monitoring (IOM) merupakan suatu teknik pembedahan yang bertujuan agar eksisi tumor dilakukan semaksimal mungkin, dengan meminimalkan defisit neurologis akibat pembedahan. Penanganan anestesi pada eksisi tumor IDIM dengan bantuan IOM ini, seorang ahli anestesi perlu menguasai ilmu dan keterampilan neuroanestesi untuk pembedahan tulang belakang, selain itu juga pemilihan teknik, jenis dan dosis obat yang mendukung pelaksanaan pembedahan dengan IOM ini. Seorang laki-laki usia 52 tahun dengan tumor IDIM setinggi vertebra cervical 5–6 menjalani pembedahan eksisi tumor dengan bantuan IOM. Pembedahan dilakukan di bawah pengaruh anestesi umum dengan induksi intravena. Laringoskopi dilakukan dengan video laryngoscope. Pembedahan dilakukan dengan panduan IOM, selama anestesi diberikan total intravenous anesthesia tanpa pemberian pelumpuh otot tambahan setelah intubasi. Pembedahan berlangsung selama enam jam dan tumor dapat terangkat seluruhnya. Tantangan selama periode perioperatif adalah penilaian dan persiapan prabedah yang teliti, posisi pasien dan pemilihan teknik anestesi yang tepat.Anesthesia Management for Cervical 5-6 Intradural Intramedullary (IDIM) Tumor under Intraoperative Neurophysiological Monitoring GuidanceExcision of intradural intramedullary (IDIM) tumor using intraoperative neurophysiological monitoring (IOM) is one surgical technique aiming to excise tumor as maximum as possible, with minimum neurological deficit. In anesthesia management for IDIM tumor excision under IOM guidance, an anesthesiologist is required to master neuroanesthesia knowledge and skill, especially for spine surgery. Moreover, understanding the art of anesthesia technique, drug and dose supporting surgery with IOM. A male patient, 52 years old, with IDIM tumor at the level of cervical 5-6th underwent surgery for tumor excision using IOM. Surgery was done under general anesthesia, started with intravenous induction, and intubation was done using video laryngoscope. Surgery was done under IOM guidance, total intravenous anesthesia was implemented and no additional muscle relaxant was given after intubation. Surgery lasted for six hours and tumor was resected completely. Challenges during perioperative period are meticulous preoperative assessment and preparation, patient positioning and appropriate anesthesia technique.

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